# BLOOM THERAPY, PLC

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

## Provider details

- **NPI number:** 1740901388
- **Authorized official:** ZACHERY NIELSEN LMHC, NCC (OWNER)
- **Authorized official phone:** (563) 265-5063

## Contact information

- **Practice address:** 3350 UTICA RIDGE RD, BETTENDORF, IA 52722-1616
- **Practice address phone:** (563) 265-5063
- **Practice address fax:** (877) 583-4958
- **Mailing address:** 3350 UTICA RIDGE RD, BETTENDORF, IA 52722-1616
- **Mailing address phone:** (563) 265-5063
- **Mailing address fax:** (877) 583-4958

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 101YS0200X | School Counselor | — | NULL | — |
| 101YS0200X | School Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 09/12/2022
- **Last updated:** 03/03/2023