| Bloom Behavioral Health Llc | |
|
160 Blue Lake St Richmond Hill GA 31324-4435 | |
| (601) 896-2102 | |
| Not Available |
| Full Name | Bloom Behavioral Health Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 160 Blue Lake St, Richmond Hill, Georgia |
| Authorized Official Name and Position | Brandy Crawford (PMHNP) |
| Authorized Official Contact | 6018962102 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloom Behavioral Health Llc 160 Blue Lake St Richmond Hill GA 31324-4435 Ph: (601) 896-2102 | Bloom Behavioral Health Llc 160 Blue Lake St Richmond Hill GA 31324-4435 Ph: (601) 896-2102 |
| NPI Number | 1073351805 |
|---|---|
| Provider Enumeration Date | 07/16/2024 |
| Last Update Date | 07/16/2024 |
| Certification Date | 07/16/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073351805 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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