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General NPI Number Information
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NPI Number | 1124971205
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Entity Type | Organization
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Legal Business Name | BLOOM WELLNESS LLC
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Dates
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Enumeration Date | 02/18/2026
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 509 SCOTT AVE STE 2D
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City | WOODLAND PARK
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State | CO
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Zip | 80863-1294
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Country | US
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Telephone | 719-286-9077
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Fax | 719-431-6193
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Provider Business Mailing Address
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Address Line | 417 BEAVER POND RD
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City | DIVIDE
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State | CO
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Zip | 80814-7792
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Country | US
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Telephone | 719-286-9077
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Fax | 719-431-6193
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Authorized Official
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Title or Position | OWNER, CLINICIAN
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Name | LAURA MAGNUSON
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Credential | LCSW
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Telephone | 303-408-8056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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