1780335737 NPI number — BLOOM PSYCHOTHERAPY AND EMPOWERMENT SERVICES

Table of content: (NPI 1780335737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780335737 NPI number — BLOOM PSYCHOTHERAPY AND EMPOWERMENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLOOM PSYCHOTHERAPY AND EMPOWERMENT SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780335737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4501 JACKSON ST EXT STE C
Provider Second Line Business Mailing Address:
BOX #285
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71303-2555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-723-7237
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5420 DOWNING ST APT 8C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301-3120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-723-7237
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2022

Additional Information

Authorized Official

Authorized Official Last Name:
COPELAND
Authorized Official First Name:
MARISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
318-446-0592

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com