Provider Demographics
NPI:1619680998
Name:BLOOM PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:BLOOM PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-879-8560
Mailing Address - Street 1:2910 E 57TH AVE, STE 5
Mailing Address - Street 2:PO BOX 126
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7028
Mailing Address - Country:US
Mailing Address - Phone:509-557-0450
Mailing Address - Fax:509-757-8981
Practice Address - Street 1:104 S FREYA ST STE 212
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4871
Practice Address - Country:US
Practice Address - Phone:509-557-0450
Practice Address - Fax:509-757-8981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder