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General NPI Number Information
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NPI Number | 1083972897
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Entity Type | Organization
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Legal Business Name | BLOOM ART AND INTEGRATED THERAPIES LLC
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 700 W VIRGINIA ST STE 204
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City | MILWAUKEE
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State | WI
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Zip | 53204-1549
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Country | US
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Telephone | 414-207-4565
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Fax | 414-348-0206
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Provider Business Mailing Address
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Address Line | 700 W VIRGINIA ST STE 204
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City | MILWAUKEE
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State | WI
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Zip | 53204-1549
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Country | US
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Telephone | 414-207-4565
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Fax | 414-348-0206
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Authorized Official
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Title or Position | OWNER, PSYCHOTHERAPIST
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Name | MRS. EMILY C NOLAN
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Credential | MA, LPC ATR-BC
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Telephone | 414-378-0602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 4057-125
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License Number State | WI
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