Provider Demographics
NPI:1467223792
Name:BLOOM PROFESSIONAL COUNSELING PLLC
Entity Type:Organization
Organization Name:BLOOM PROFESSIONAL COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:MACIE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:BABO
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:612-246-7469
Mailing Address - Street 1:1923 WOODLAND SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6302
Mailing Address - Country:US
Mailing Address - Phone:612-246-7469
Mailing Address - Fax:
Practice Address - Street 1:11999 KATY FWY STE 450
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1627
Practice Address - Country:US
Practice Address - Phone:612-246-7469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty