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General NPI Number Information
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NPI Number | 1801716592
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Entity Type | Organization
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Legal Business Name | BLOOM THERAPY, LLC
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Dates
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Enumeration Date | 07/21/2026
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Last Update Date | 07/21/2026
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Provider Practice Location Address
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Address Line | 1915 NE STUCKI AVE STE 400
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City | HILLSBORO
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State | OR
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Zip | 97006-6938
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Country | US
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Telephone | 971-545-4936
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Fax | 971-250-0133
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Provider Business Mailing Address
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Address Line | 1915 NE STUCKI AVE STE 400
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City | HILLSBORO
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State | OR
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Zip | 97006-6938
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Country | US
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Telephone | 971-545-4936
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Fax | 971-250-0133
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Authorized Official
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Title or Position | PSYCHOTHERAPIST/OWNER
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Name | NAIYANA CHANTARABUNCHORN
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Credential | PHD, NCC, LPC
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Telephone | 971-545-4936
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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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