Provider Demographics
NPI:1740141795
Name:BLOOM, JANE (LMHC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1549
Mailing Address - Street 2:
Mailing Address - City:MESILLA
Mailing Address - State:NM
Mailing Address - Zip Code:88046-1549
Mailing Address - Country:US
Mailing Address - Phone:575-323-8900
Mailing Address - Fax:575-267-6228
Practice Address - Street 1:350 EL MOLINO BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2915
Practice Address - Country:US
Practice Address - Phone:575-323-8900
Practice Address - Fax:575-267-6228
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB20250794101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty