Provider Demographics
NPI:1467268045
Name:BLOOM COUNSELING & CONSULTATION
Entity type:Organization
Organization Name:BLOOM COUNSELING & CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORRIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:253-380-0038
Mailing Address - Street 1:259 HARROWGATE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1596
Mailing Address - Country:US
Mailing Address - Phone:253-380-0038
Mailing Address - Fax:
Practice Address - Street 1:1824 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4605
Practice Address - Country:US
Practice Address - Phone:253-380-0038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health