MEDICARE: SOMALOOM, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1730034679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMALOOM, LLC

Provider Business Mailing Address
First Line	:	5005 W LAUREL ST STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-3896
Country	:	US
Telephone Number	:	656-256-5081
Fax Number	:

Provider Business Practice Location Address
First Line	:	11656 BAY HARBOR BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	FL
Zip	:	33576
Country	:	US
Telephone Number	:	656-256-5081
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIA LAM
Credential	:	LMHC
Telephone Number	:	656-256-5081

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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