Organization
BLOOM365
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACQUELINE UHLEMANN LPC (CLINICAL DIRECTOR)
(602) 820-3925
Entity
Organization
Contact information
Practice address
1715 W NORTHERN AVE, PHOENIX, AZ 85021-5472
(888) 606-4673
Mailing address
20403 N LAKE PLEASANT RD # 117-492, PEORIA, AZ 85382-9702
(888) 606-4673
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/28/2021
Last updated
10/28/2021
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