Provider Demographics
NPI:1457179913
Name:NEURO BLOOM COUNSELING AND NEUROFEEDBACK, PLLC
Entity type:Organization
Organization Name:NEURO BLOOM COUNSELING AND NEUROFEEDBACK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TANJA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORENC
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, BCN
Authorized Official - Phone:720-490-9939
Mailing Address - Street 1:13654 XAVIER LN STE 201
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-3608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1333 W 120TH AVE STE 218
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80234-2710
Practice Address - Country:US
Practice Address - Phone:720-523-1067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEURO BLOOM COUNSELING AND NEUROFEEDBACK, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty