Provider Demographics
NPI:1922164144
Name:BLOOMER COUNSELING AND CONSULTING, INC.
Entity Type:Organization
Organization Name:BLOOMER COUNSELING AND CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:VIVIEN
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC MAC
Authorized Official - Phone:503-362-9466
Mailing Address - Street 1:1340 CHEMEKETA ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4151
Mailing Address - Country:US
Mailing Address - Phone:503-362-9466
Mailing Address - Fax:
Practice Address - Street 1:1340 CHEMEKETA ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4151
Practice Address - Country:US
Practice Address - Phone:503-362-9466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR501827101YA0400X
ORC1117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty