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General NPI Number Information
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NPI Number | 1265349914
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Entity Type | Organization
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Legal Business Name | BLOOM HARBOR COLLECTIVE, PLLC
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Dates
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Enumeration Date | 08/27/2026
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Last Update Date | 08/27/2026
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Provider Practice Location Address
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Address Line | 6816 HENRY DR
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-2106
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Country | US
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Telephone | 469-868-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 6245 RUFE SNOW DR. STE. 280 PMB 1050
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City | FORT WORTH
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State | TX
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Zip | 76148-3352
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Country | US
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Telephone | 469-868-4500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHENYA JOSEPH
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Credential | APRN
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Telephone | 662-310-2341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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