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General NPI Number Information
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NPI Number | 1528442464
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Entity Type | Organization
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Legal Business Name | BLOOM COUNSELING LLC
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Dates
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Enumeration Date | 07/09/2015
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Last Update Date | 07/09/2015
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Provider Practice Location Address
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Address Line | 510 HARTBROOK DR STE 201
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City | HARTLAND
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State | WI
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Zip | 53029-1444
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Country | US
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Telephone | 262-528-2015
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Fax | 866-284-8107
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Provider Business Mailing Address
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Address Line | 510 HARTBROOK DR STE 201
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City | HARTLAND
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State | WI
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Zip | 53029-1444
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Country | US
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Telephone | 262-528-2015
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Fax | 866-284-8107
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Authorized Official
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Title or Position | PARTNER COUNSELOR
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Name | MISS E LEE GARZA
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Credential | LPC
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Telephone | 262-528-2015
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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 | 5606-125
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License Number State | WI
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