MEDICARE: DESERT BLOOM THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1225924202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT BLOOM THERAPY LLC

Provider Business Mailing Address
First Line	:	6113 HIGH PLAINS RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-7255
Country	:	US
Telephone Number	:	575-449-5191
Fax Number	:

Provider Business Practice Location Address
First Line	:	6113 HIGH PLAINS RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-7255
Country	:	US
Telephone Number	:	575-449-5191
Fax Number	:

Authorized Official
Title or Position	:	LCSW/OWNER
Name	:	JESSICA WILLIAMS
Credential	:
Telephone Number	:	469-207-5789

Provider Enumeration Date	:	06/16/2025
Last Update Date	:	11/15/2025

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