Provider Demographics
NPI:1083972897
Name:BLOOM ART AND INTEGRATED THERAPIES LLC
Entity type:Organization
Organization Name:BLOOM ART AND INTEGRATED THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:C
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC ATR-BC
Authorized Official - Phone:414-378-0602
Mailing Address - Street 1:700 W VIRGINIA ST STE 204
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-1549
Mailing Address - Country:US
Mailing Address - Phone:414-207-4565
Mailing Address - Fax:414-348-0206
Practice Address - Street 1:700 W VIRGINIA ST STE 204
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-1549
Practice Address - Country:US
Practice Address - Phone:414-207-4565
Practice Address - Fax:414-348-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4057-125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health