Organization
BLOOM BEHAVIORAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MADELINE LISA REHM LISW-CP (OWNER)
(864) 383-0384
Entity
Organization
Contact information
Practice address
25B RUSHMORE DR, GREENVILLE, SC 29615-1254
(864) 383-0384
Mailing address
25B RUSHMORE DR, GREENVILLE, SC 29615-1254
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
11284
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SW1450
—
SC
Enumeration date
03/31/2018
Last updated
06/16/2018
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