Provider Demographics
NPI:1447846258
Name:NEW BLOOM THERAPY, LLC
Entity type:Organization
Organization Name:NEW BLOOM THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMOS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-248-9903
Mailing Address - Street 1:63200 WISHING WELL LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8272
Mailing Address - Country:US
Mailing Address - Phone:541-248-9903
Mailing Address - Fax:
Practice Address - Street 1:1005 SW DISK DR STE 104
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3385
Practice Address - Country:US
Practice Address - Phone:541-248-9903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty