Bloom Behavioral Health LLC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

BLOOM BEHAVIORAL HEALTH LLC

Practice address

2473 Karl Dr
Port Orange, FL 32128-6511

Phone

(904) 788-9474

Fax

(760) 205-4866

NPI assigned

May 28, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Elena Gonzalez, LMFTNPI 1164790143

Title

Owner

Phone

(904) 788-9474

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elena K Gonzalez, LMFT

  • Marriage & Family Therapist
  • Port Orange, FL
  • NPI 1164790143
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683763200000",
    "number": "1114593399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 OLIVINE CT",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320860350",
            "telephone_number": "904-788-9474",
            "fax_number": "760-205-4866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2473 KARL DR",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321286511",
            "telephone_number": "904-788-9474",
            "fax_number": "760-205-4866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-28",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "ELENA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-788-9474",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1164790143",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI 1",
            "identifier": "1164790143",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://bloombehavioralhealth.org/",
            "affiliation": "N",
            "endpointDescription": "website",
            "address_1": "2473 Karl Dr",
            "city": "Port Orange",
            "state": "FL",
            "country_code": "US",
            "postal_code": "321286511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sarah Blake
• Loretta Blanchard, NP
• Brandon Blanding
• Stephanie Blanton
• Lindsay Blaum, AGPCNP
• Willis Blower, LCSW
• Blue Ocean Dermatology LLC
• Kimberly Boan, COTA
• Rishi Tushar Bodalia, DC
• Connie Jeanne Bodnarik

• Marriage & Family Therapist in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Marriage & Family Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.