Provider Demographics
NPI:1275352957
Name:DAHLIA BLOOM THERAPY PLLC
Entity type:Organization
Organization Name:DAHLIA BLOOM THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-962-0698
Mailing Address - Street 1:7545 S WESTERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620
Mailing Address - Country:US
Mailing Address - Phone:630-962-0698
Mailing Address - Fax:
Practice Address - Street 1:7545 S WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620
Practice Address - Country:US
Practice Address - Phone:630-962-0698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty