Provider Demographics
NPI:1497352942
Name:BLOOM CHILD THERAPISTS PLLC
Entity type:Organization
Organization Name:BLOOM CHILD THERAPISTS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCPC
Authorized Official - Phone:303-968-1390
Mailing Address - Street 1:19590 E MAINSTREET STE 100-5
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7302
Mailing Address - Country:US
Mailing Address - Phone:303-968-1390
Mailing Address - Fax:
Practice Address - Street 1:19590 E MAINSTREET STE 100-5
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7302
Practice Address - Country:US
Practice Address - Phone:303-968-1390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty