| Bloom Wellness Llc | |
|
509 Scott Ave Ste 2d Woodland Park CO 80863-1294 | |
| (303) 408-8056 | |
| Not Available |
| Full Name | Bloom Wellness Llc |
|---|---|
| Speciality | Social Worker |
| Location | 509 Scott Ave Ste 2d, Woodland Park, Colorado |
| Authorized Official Name and Position | Laura Magnuson (OWNER, LCSW) |
| Authorized Official Contact | 3034088056 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloom Wellness Llc 417 Beaver Pond Rd Divide CO 80814-7792 Ph: (303) 408-8056 | Bloom Wellness Llc 509 Scott Ave Ste 2d Woodland Park CO 80863-1294 Ph: (303) 408-8056 |
| NPI Number | 1760177919 |
|---|---|
| Provider Enumeration Date | 04/05/2023 |
| Last Update Date | 12/18/2024 |
| Certification Date | 12/18/2024 |
| Medicare PECOS PAC ID | 5294189080 |
|---|---|
| Medicare Enrollment ID | O20230927003392 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760177919 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Timothy Lee Corbley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114630977 PECOS PAC ID: 0648636506 Enrollment ID: I20230518001422 |
| Provider Name | Laura Magnuson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881093839 PECOS PAC ID: 6103270996 Enrollment ID: I20230927003482 |
| Provider Name | Deborah B Elliott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306215629 PECOS PAC ID: 5193172898 Enrollment ID: I20231116002016 |
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