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General NPI Number Information
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NPI Number | 1689427775
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Entity Type | Organization
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Legal Business Name | THE BLOOM STUDIO AND COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 04/09/2024
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 1605 SOUTHCROSS DR W STE 100
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City | BURNSVILLE
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State | MN
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Zip | 55306-7013
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Country | US
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Telephone | 612-963-4242
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Fax |
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Provider Business Mailing Address
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Address Line | 8547 GROVE CIR
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City | SHAKOPEE
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State | MN
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Zip | 55379-8096
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Country | US
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Telephone | 612-963-4242
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELLIESHA HAHN
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Credential | MA, LPCC, ATR
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Telephone | 612-963-4242
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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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