| Bloom Behavioral Health Partners Pllc | |
|
1514 Wealthy St Se Ste 242 Grand Rapids MI 49506-2755 | |
| (616) 202-2138 | |
| (616) 228-8990 |
| Full Name | Bloom Behavioral Health Partners Pllc |
|---|---|
| Speciality | Counselor |
| Location | 1514 Wealthy St Se Ste 242, Grand Rapids, Michigan |
| Authorized Official Name and Position | Matthew Thatcher (OWNER / COUNSELOR) |
| Authorized Official Contact | 6162022138 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloom Behavioral Health Partners Pllc 1514 Wealthy St Se Ste 242 Grand Rapids MI 49506-2755 Ph: (616) 202-2138 | Bloom Behavioral Health Partners Pllc 1514 Wealthy St Se Ste 242 Grand Rapids MI 49506-2755 Ph: (616) 202-2138 |
| NPI Number | 1174176366 |
|---|---|
| Provider Enumeration Date | 07/17/2019 |
| Last Update Date | 02/25/2022 |
| Certification Date | 02/25/2022 |
| Medicare PECOS PAC ID | 3678959632 |
|---|---|
| Medicare Enrollment ID | O20220929000772 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174176366 | NPI | - | NPPES |
| Provider Name | Erin M Dault |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720122666 PECOS PAC ID: 5890895965 Enrollment ID: I20070703000485 |
| Provider Name | Kayleigh Georgia Parent |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306193198 PECOS PAC ID: 8426345133 Enrollment ID: I20210916003035 |
| Provider Name | Teresa Hultink |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922774975 PECOS PAC ID: 1850743758 Enrollment ID: I20240116003837 |
| Provider Name | Matthew A Thatcher |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285917997 PECOS PAC ID: 2365828035 Enrollment ID: I20240122000814 |
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