Organization
BLOOM MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LEIGH GALLE PMHNP (OWNER)
(228) 343-0325
Entity
Organization
Contact information
Practice address
933 TOMMY MUNRO DR., SUITE C, BILOXI, MS 39532
(228) 343-0325
Mailing address
PO BOX 8592, BILOXI, MS 39535-8592
(225) 343-0325
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R864186
STATE LICENSE
MS
Enumeration date
11/12/2019
Last updated
08/05/2020
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