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General NPI Number Information
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NPI Number | 1538968607
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Entity Type | Organization
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Legal Business Name | IBLOOM WELLNESS CLINIC PLLC
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 3838 OAK LAWN AVE STE 1000
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City | DALLAS
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State | TX
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Zip | 75219-4511
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Country | US
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Telephone | 682-553-7827
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR STE 100
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City | AUSTIN
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State | TX
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Zip | 78731-4298
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Country | US
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Telephone | 682-553-7827
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | CHRISTOLOGUS OBI
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Credential |
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Telephone | 972-375-1634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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