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General NPI Number Information
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NPI Number | 1801738307
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Entity Type | Organization
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Legal Business Name | INTERNALLY BLOOM LLC
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Dates
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Enumeration Date | 04/06/2026
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Last Update Date | 04/06/2026
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Provider Practice Location Address
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Address Line | 5004 S U ST STE 200
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City | FORT SMITH
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State | AR
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Zip | 72903-3600
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Country | US
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Telephone | 479-888-8234
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Fax | 479-888-8234
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Provider Business Mailing Address
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Address Line | 5004 S U ST STE 200
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City | FORT SMITH
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State | AR
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Zip | 72903-3600
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Country | US
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Telephone | 479-888-8234
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Fax | 479-888-8234
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Authorized Official
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Title or Position | OWNER/MANAGER/PROVIDER
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Name | LISA SISCO
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Credential | LPC
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Telephone | 479-888-8234
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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