Bloom Wellness LLC
Social Worker, Clinical in Cripple Creek, CO. Organization (NPI-2).
NPI number1093523904
StatusActive
Last updated in NPPESDec 23, 2024
Details
- NPI
- 1093523904
- Entity type
- Organization (NPI-2)
- Legal business name
- Bloom Wellness LLC
- Organization subpart
- Yes
- Enumeration date
- Dec 23, 2024
- Certification date
- Dec 18, 2024
- Last updated
- Dec 23, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | – | – | Yes |
Practice location
100 W Bennett AvenueCripple Creek, CO 80813
Phone 719-286-9077
Mailing address
417 Beaver Pond RdDivide, CO 80814-7792
Phone 719-286-9077
Authorized official
Laura Magnuson
Owner, Supervisor, Clinician
3034088056
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