Provider Demographics
NPI:1952011959
Name:IN BLOOM COUNSELING PLLC
Entity Type:Organization
Organization Name:IN BLOOM COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RALPH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:620-200-2843
Mailing Address - Street 1:2639 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-3315
Mailing Address - Country:US
Mailing Address - Phone:620-200-2843
Mailing Address - Fax:
Practice Address - Street 1:6130 E 32ND ST STE 109
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5454
Practice Address - Country:US
Practice Address - Phone:620-200-2843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health