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Contact Information

BLOOM PSYCHOLOGICAL SERVICES, LLC
1520 29TH AVE
SUITE 31
GULFPORT, MS39501-2843
 Phone: 228-547-2273
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for BLOOM PSYCHOLOGICAL SERVICES LLC · (Female)

NPI # 1083098495
Status Active
Credentials
Entity Individual
Enumeration date 07/15/2015
Last updated 07/15/2015 - About 11 years ago
Sole proprietor 1 Not specified
Identifiers
  • MS License # 54965
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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