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General NPI Number Information
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NPI Number | 1396452900
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Entity Type | Organization
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Legal Business Name | DESERT BLOOM COUNSELING, PLLC
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Dates
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Enumeration Date | 11/02/2022
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 2755 SILVER CREEK RD STE 203
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-8347
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Country | US
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Telephone | 928-299-2678
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Fax | 928-350-6405
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Provider Business Mailing Address
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Address Line | 2755 SILVER CREEK RD STE 203
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-8347
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Country | US
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Telephone | 928-299-2678
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Fax | 928-350-6405
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | JENNIFER STAGGS
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Credential | MSW, LCSW
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Telephone | 928-299-2678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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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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