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General NPI Number Information
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NPI Number | 1447191812
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Entity Type | Organization
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Legal Business Name | INNER BLOOM THERAPY, LLC
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Dates
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Enumeration Date | 04/01/2026
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Last Update Date | 04/01/2026
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Provider Practice Location Address
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Address Line | 15460 W CAPITOL DR STE 210
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City | BROOKFIELD
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State | WI
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Zip | 53005-2632
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Country | US
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Telephone | 515-450-7409
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Fax |
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Provider Business Mailing Address
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Address Line | 832 LYNNEWOOD DR
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City | WAUKESHA
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State | WI
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Zip | 53188-5457
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Country | US
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Telephone | 515-450-7409
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | JAMIE CONSAMUS
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Credential | LPC
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Telephone | 515-450-7409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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