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General NPI Number Information
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NPI Number | 1184573024
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Entity Type | Organization
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Legal Business Name | BLOOM TRAUMA THERAPY LLC
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Dates
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Enumeration Date | 01/23/2026
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 6001 MOON ST NE APT 2233
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-1456
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Country | US
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Telephone | 505-461-0935
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Fax | 505-386-1776
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Provider Business Mailing Address
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Address Line | 6001 MOON ST NE APT 2233
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-1456
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LPC
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Name | SARAI PEGUERO
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Credential | MA
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Telephone | 505-461-0935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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