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General NPI Number Information
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NPI Number | 1336655174
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Entity Type | Organization
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Legal Business Name | BLOOM THERAPY & WELLNESS
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 103 E HOLLY ST STE 522
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City | BELLINGHAM
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State | WA
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Zip | 98225-4728
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Country | US
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Telephone | 360-988-3432
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Fax |
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Provider Business Mailing Address
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Address Line | 103 E HOLLY ST STE 522
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City | BELLINGHAM
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State | WA
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Zip | 98225-4728
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Country | US
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Telephone | 360-988-3432
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | APRIL E. MULLEN
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Credential | LMHC
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Telephone | 360-988-3432
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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 | WA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 604156568
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License Number State | WA
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