| Inner Bloom Professional Counseling Services Llc | |
|
19330 S 208th Pl Queen Creek AZ 85142-1615 | |
| (520) 517-8223 | |
| Not Available |
| Full Name | Inner Bloom Professional Counseling Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 19330 S 208th Pl, Queen Creek, Arizona |
| Authorized Official Name and Position | Chantal Rose Castillo (OWNER/MANAGER) |
| Authorized Official Contact | 5205178223 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inner Bloom Professional Counseling Services Llc 19330 S 208th Pl Queen Creek AZ 85142-1615 Ph: (520) 517-8223 | Inner Bloom Professional Counseling Services Llc 19330 S 208th Pl Queen Creek AZ 85142-1615 Ph: (520) 517-8223 |
| NPI Number | 1316746357 |
|---|---|
| Provider Enumeration Date | 03/12/2025 |
| Last Update Date | 03/12/2025 |
| Certification Date | 03/11/2025 |
| Medicare PECOS PAC ID | 4789108705 |
|---|---|
| Medicare Enrollment ID | O20250410002545 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316746357 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Chantal Rose Castillo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851989651 PECOS PAC ID: 5698299618 Enrollment ID: I20250410002673 |
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