Provider Demographics
NPI:1689254013
Name:WISDOM & BLOOM PLLC
Entity Type:Organization
Organization Name:WISDOM & BLOOM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARTONE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:702-525-6913
Mailing Address - Street 1:2446 GRANADA BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1341
Mailing Address - Country:US
Mailing Address - Phone:702-525-6913
Mailing Address - Fax:702-964-1371
Practice Address - Street 1:1180 N. TOWN CENTER DR.
Practice Address - Street 2:100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144
Practice Address - Country:US
Practice Address - Phone:702-525-6913
Practice Address - Fax:702-964-1371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1601614218OtherDL