Provider Demographics
NPI:1407841299
Name:BLOOM COUNSELING & FAMILY SERVICES CORPORATION
Entity Type:Organization
Organization Name:BLOOM COUNSELING & FAMILY SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:713-956-8194
Mailing Address - Street 1:11500 NW FWY
Mailing Address - Street 2:SUITE 465
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092
Mailing Address - Country:US
Mailing Address - Phone:713-956-8194
Mailing Address - Fax:713-683-1674
Practice Address - Street 1:11500 NW FWY
Practice Address - Street 2:SUITE 465
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092
Practice Address - Country:US
Practice Address - Phone:713-956-8194
Practice Address - Fax:713-683-1674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156174801Medicaid
TX00840YMedicare ID - Type Unspecified