MEDICARE: MS. JESSICA L BLOOME MA, LPCC

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	101YP2500X	Professional Counselor	CTB-2023-0337	NM

General Provider Information

NPI Number	:	1255995577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA L BLOOME MA, LPCC

Provider Business Mailing Address
First Line	:	9955 OSUNA RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2255
Country	:	US
Telephone Number	:	505-585-2437
Fax Number	:

Provider Business Practice Location Address
First Line	:	9955 OSUNA RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2255
Country	:	US
Telephone Number	:	505-585-2437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	12/16/2025

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