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General NPI Number Information
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NPI Number | 1295315026
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Entity Type | Organization
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Legal Business Name | BLOOM CHILD AND FAMILY THERAPY
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 419 N 1ST ST UNIT D
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City | MONTROSE
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State | CO
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Zip | 81401-3703
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Country | US
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Telephone | 970-765-7162
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Fax |
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Provider Business Mailing Address
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Address Line | 419 N 1ST ST UNIT D
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City | MONTROSE
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State | CO
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Zip | 81401-3703
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Country | US
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Telephone | 970-765-7162
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | JESSICA CORRIGAN
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Credential | LCSW
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Telephone | 317-373-0529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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