MEDICARE: BLOOM COUNSELING COLLECTIVE 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1326991183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM COUNSELING COLLECTIVE LLC

Provider Business Mailing Address
First Line	:	5589 DUNHAM RD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3657
Country	:	US
Telephone Number	:	216-282-9667
Fax Number	:

Provider Business Practice Location Address
First Line	:	5589 DUNHAM RD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3657
Country	:	US
Telephone Number	:	216-282-9667
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	THAILIA MORTON
Credential	:	LPCC-S
Telephone Number	:	216-282-9667

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	02/19/2026

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