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General NPI Number Information
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NPI Number | 1881268654
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Entity Type | Organization
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Legal Business Name | BLOOM WOMEN'S COUNSELING, CONSULTING, AND WELLNESS, LLC.
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Dates
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Enumeration Date | 05/17/2021
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 112 E DUDLEY ST
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City | MAUMEE
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State | OH
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Zip | 43537-3366
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Country | US
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Telephone | 419-326-5732
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Fax | 419-715-0776
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Provider Business Mailing Address
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Address Line | 112 E DUDLEY ST
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City | MAUMEE
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State | OH
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Zip | 43537-3366
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Country | US
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Telephone | 419-326-5732
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Fax | 419-715-0776
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | ASHLEY BUSH
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Credential | MSW, LISW-S, PMH-C
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Telephone | 419-326-5732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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