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General NPI Number Information
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NPI Number | 1467223792
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Entity Type | Organization
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Legal Business Name | BLOOM PROFESSIONAL COUNSELING PLLC
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 11999 KATY FWY STE 450
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City | HOUSTON
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State | TX
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Zip | 77079-1627
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Country | US
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Telephone | 612-246-7469
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Fax |
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Provider Business Mailing Address
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Address Line | 1923 WOODLAND SPRINGS ST
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City | HOUSTON
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State | TX
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Zip | 77077-6302
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Country | US
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Telephone | 612-246-7469
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MS. MACIE LEA BABO
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Credential | MA LPC
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Telephone | 612-246-7469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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