Organization
BLOOM BEHAVIORAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER MARTIN (LMFT)
(620) 423-5356
Entity
Organization
Contact information
Practice address
3922 CHIPMUNK DR, JOPLIN, MO 64804-8711
(620) 423-5356
Mailing address
3922 CHIPMUNK DR, JOPLIN, MO 64804-8711
(620) 423-5356
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
09/28/2021
Last updated
09/28/2021
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