| Bloom Behavioral Health Llc | |
|
2473 Karl Dr Port Orange FL 32128-6511 | |
| (904) 788-9474 | |
| (760) 205-4866 |
| Full Name | Bloom Behavioral Health Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 2473 Karl Dr, Port Orange, Florida |
| Authorized Official Name and Position | Elena Gonzalez (OWNER) |
| Authorized Official Contact | 9047889474 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloom Behavioral Health Llc 32 Olivine Ct Saint Augustine FL 32086-0350 Ph: (904) 788-9474 | Bloom Behavioral Health Llc 2473 Karl Dr Port Orange FL 32128-6511 Ph: (904) 788-9474 |
| NPI Number | 1114593399 |
|---|---|
| Provider Enumeration Date | 05/28/2021 |
| Last Update Date | 05/11/2023 |
| Certification Date | 05/11/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114593399 | NPI | - | NPPES |
| 1164790143 | Other | NPI | |
| 1164790143 | Other | CA | NPI 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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