| NPI | 1013871540 |
|---|---|
| Doing Business As | BLOOM AVENUE THERAPY CO |
| Entity Type | Organization |
| Authorized Contact | CASSIE MAHAN Licensed Professional Counselor 580-330-1398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Enumeration Date | 2025-12-10 |
| Last Update Date | 2025-12-10 |