NPIMap

Organization Active NPI

In Bloom Mental Health Counseling, LLC

  • Mental Health Counselor
  • Brooklyn, NY
National Provider Identifier
1215547831
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
IN BLOOM MENTAL HEALTH COUNSELING, LLC
Practice address
247 Prospect Ave Ste 4H
Brooklyn, NY 11215-8403
Phone
(347) 509-7127
NPI assigned
Aug 7, 2020
Last updated
Aug 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

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

Authorized official

Name
Shandelle Hether-Gray, LMHC, LCPCNPI 1548626336
Title
Owner
Phone
(347) 509-7127

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

247 Prospect Ave Ste 4H
Brooklyn, NY 11215-8403

Mailing address

2324 W Joppa Rd Ste 410
Lutherville, MD 21093-4620
Phone (443) 446-4718

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240403003948 MD Part B Supplier - Clinic/Group Practice 8426496886 Receives reassigned benefits from 1 practitioner
Practice locations: Lutherville Timonium, MD

National Provider Directory

National Provider Directory

Locations

2324 W Joppa Rd
Ste 410
Timonium, MD 21093
Phone (347) 509-7127

247 Prospect Ave
Ste 4H
Brooklyn, NY 11215
Phone (347) 509-7127

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1596758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660262400000",
    "number": "1215547831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2324 W JOPPA RD STE 410",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210934620",
            "telephone_number": "443-446-4718",
            "fax_number": "347-391-0191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 PROSPECT AVE STE 4H",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112158403",
            "telephone_number": "347-509-7127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IN BLOOM MENTAL HEALTH COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-07",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A",
        "authorized_official_last_name": "HETHER-GRAY",
        "authorized_official_first_name": "SHANDELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-509-7127",
        "authorized_official_credential": "LMHC, LCPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.