Provider Demographics
NPI:1386248656
Name:BLOOM COUNSELING LLC
Entity type:Organization
Organization Name:BLOOM COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGLOTHREN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:985-790-7763
Mailing Address - Street 1:204 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-3859
Mailing Address - Country:US
Mailing Address - Phone:225-205-0549
Mailing Address - Fax:
Practice Address - Street 1:1000 PLANTATION RD STE 1A
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4264
Practice Address - Country:US
Practice Address - Phone:985-790-7763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)