Provider Demographics
NPI:1598347692
Name:IN BLOOM COUNSELING AND WELLNESS, LLC
Entity Type:Organization
Organization Name:IN BLOOM COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUELY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-465-2271
Mailing Address - Street 1:11885 FICTION AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5120
Mailing Address - Country:US
Mailing Address - Phone:321-465-2271
Mailing Address - Fax:
Practice Address - Street 1:7157 NARCOOSSEE RD # 1016
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5533
Practice Address - Country:US
Practice Address - Phone:321-718-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty