MEDICARE: ASHLEY BLOOM

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	247200000X	Other Technician
2	101YP2500X	Professional Counselor	640101637	MI

General Provider Information

NPI Number	:	1922462415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY BLOOM

Provider Business Mailing Address
First Line	:	2510 S TELEGRAPH RD # L231
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-0241
Country	:	US
Telephone Number	:	269-389-0432
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 S TELEGRAPH RD # L231
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-0241
Country	:	US
Telephone Number	:	269-389-0432
Fax Number	:

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

Provider Enumeration Date	:	04/11/2016
Last Update Date	:	12/28/2023

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Directions to “ ASHLEY BLOOM ” Practice Location

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