Provider Demographics
NPI:1790067544
Name:BLOOM, NICOLE JOYCE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:JOYCE
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WOCICKI LN
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-8700
Mailing Address - Country:US
Mailing Address - Phone:307-746-8107
Mailing Address - Fax:
Practice Address - Street 1:420 DEANNE AVE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-2936
Practice Address - Country:US
Practice Address - Phone:307-746-4456
Practice Address - Fax:307-746-4470
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1592101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional