MEDICARE: BLOOM BEHAVIORAL SOLUTIONS, INC.

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1881953347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM BEHAVIORAL SOLUTIONS, INC.

Provider Business Mailing Address
First Line	:	997 ATLANTIC BLVD
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-3311
Country	:	US
Telephone Number	:	904-647-1849
Fax Number	:	904-647-2625

Provider Business Practice Location Address
First Line	:	997 ATLANTIC BLVD
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-3311
Country	:	US
Telephone Number	:	904-647-1849
Fax Number	:	904-647-2625

Authorized Official
Title or Position	:	CEO
Name	:	GENEVIEVE HICKEY COVINGTON
Credential	:	BCBA
Telephone Number	:	904-647-1849

Provider Enumeration Date	:	05/03/2012
Last Update Date	:	01/16/2025

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