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General NPI Number Information
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NPI Number | 1912845926
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Entity Type | Organization
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Legal Business Name | BLOOM PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 03/23/2026
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Last Update Date | 03/26/2026
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Provider Practice Location Address
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Address Line | 409 W SOUTH ST
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City | STOUGHTON
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State | WI
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Zip | 53589-2459
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Country | US
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Telephone | 608-492-1301
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Fax |
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Provider Business Mailing Address
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Address Line | 2935 S FISH HATCHERY RD STE 334
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City | FITCHBURG
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State | WI
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Zip | 53711-6434
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Country | US
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Telephone | 608-492-1301
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | KATHERINE COUSIN
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Credential | MA, LPC, LMHC
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Telephone | 608-492-1301
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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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