# BLOOM BEHAVIORAL HEALTH LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114593399
- **Authorized official:** MRS. ELENA GONZALEZ LMFT (OWNER)
- **Authorized official phone:** (904) 788-9474

## Contact information

- **Practice address:** 2473 KARL DR, PORT ORANGE, FL 32128-6511
- **Practice address phone:** (904) 788-9474
- **Practice address fax:** (760) 205-4866
- **Mailing address:** 32 OLIVINE CT, SAINT AUGUSTINE, FL 32086-0350
- **Mailing address phone:** (904) 788-9474
- **Mailing address fax:** (760) 205-4866

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 05/28/2021
- **Last updated:** 05/11/2023