Healthcare Provider Details

I. General information

NPI: 1447191812
Provider Name (Legal Business Name): INNER BLOOM THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15460 W CAPITOL DR STE 210
BROOKFIELD WI
53005-2632
US

IV. Provider business mailing address

832 LYNNEWOOD DR
WAUKESHA WI
53188-5457
US

V. Phone/Fax

Practice location:
  • Phone: 515-450-7409
  • Fax:
Mailing address:
  • Phone: 515-450-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JAMIE CONSAMUS
Title or Position: THERAPIST/OWNER
Credential: LPC
Phone: 515-450-7409