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General NPI Number Information
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NPI Number | 1407676042
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Entity Type | Organization
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Legal Business Name | BLOOM WHERE PLANTED THERAPY SERVICES, PLLC
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 167 S SEGUIN AVE
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City | NEW BRAUNFELS
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State | TX
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Zip | 78130-5141
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Country | US
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Telephone | 210-645-5749
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Fax |
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Provider Business Mailing Address
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Address Line | 940 SALZACH DR
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City | NEW BRAUNFELS
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State | TX
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Zip | 78130-0362
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Country | US
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Telephone | 210-645-6749
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DESIRA CAMPOS
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Credential | LCSW
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Telephone | 210-645-5749
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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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