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General NPI Number Information
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NPI Number | 1376349043
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Entity Type | Organization
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Legal Business Name | BLOOM MINDFULLY COUNSELING PLLC
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 1212 BOSTON TPKE STE B
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City | BOLTON
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State | CT
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Zip | 06043-7451
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Country | US
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Telephone | 860-246-6284
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Fax |
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Provider Business Mailing Address
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Address Line | 86 BUFF CAP RD APT E4
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City | TOLLAND
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State | CT
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Zip | 06084-2643
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Country | US
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Telephone | 860-248-6284
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | MACKENZIE PHELPS
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Credential | LCSW
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Telephone | 860-246-6284
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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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