Provider Demographics
NPI:1306659685
Name:MOUNTAIN BLOOM PSYCHIATRY PLLC
Entity type:Organization
Organization Name:MOUNTAIN BLOOM PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:IBEANU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-454-0948
Mailing Address - Street 1:565 GREEN VILLAGE CT UNIT B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8168
Mailing Address - Country:US
Mailing Address - Phone:404-454-0948
Mailing Address - Fax:
Practice Address - Street 1:565 GREEN VILLAGE CT UNIT B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-8168
Practice Address - Country:US
Practice Address - Phone:404-454-0948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty