# BLOOM WELL COUNSELING, LLC

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

## Provider details

- **NPI number:** 1245144484
- **Authorized official:** MEKENZIE LANE LPC/MHSP (OWNER)
- **Authorized official phone:** (865) 748-8556

## Contact information

- **Practice address:** 908 W BROADWAY AVE, MARYVILLE, TN 37801-4637
- **Practice address phone:** (865) 748-8556
- **Mailing address:** 1201 CEDARWOOD LN, MARYVILLE, TN 37803-2666
- **Mailing address phone:** (865) 748-8556

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |

## Other

- **Enumeration date:** 10/02/2026
- **Last updated:** 10/02/2026