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General NPI Number Information
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NPI Number | 1427693613
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Entity Type | Organization
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Legal Business Name | BLOOM MENTAL HEALTH LLC
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 933 TOMMY MUNRO DR. SUITE C
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City | BILOXI
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State | MS
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Zip | 39532
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Country | US
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Telephone | 228-343-0325
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8592
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City | BILOXI
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State | MS
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Zip | 39535-8592
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Country | US
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Telephone | 225-343-0325
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER LEIGH GALLE
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Credential | PMHNP
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Telephone | 228-343-0325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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