NPIMap

Organization Active NPI

Super Bloom Counseling LLC

  • Professional Counselor
  • Troy, IL
National Provider Identifier
1225794761
Registry record updated Nov 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
SUPER BLOOM COUNSELING LLC
Practice address
1408 Martin Dr
Troy, IL 62294-3616
Phone
(270) 873-9007
NPI assigned
Nov 9, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2021

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

Authorized official

Name
Cheryl Jean Son, MANPI 1932718368
Title
Therapist/Owner
Phone
(270) 873-9007

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
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

1408 Martin Dr
Troy, IL 62294-3616

Mailing address

1408 Martin Dr
Troy, IL 62294-3616
Phone (270) 873-9007

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1636416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636416000000",
    "number": "1225794761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 MARTIN DR",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622943616",
            "telephone_number": "270-873-9007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1408 MARTIN DR",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622943616",
            "telephone_number": "270-873-9007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER BLOOM COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-09",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-09",
        "status": "A",
        "authorized_official_last_name": "SON",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "THERAPIST/OWNER",
        "authorized_official_telephone_number": "270-873-9007",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2021; 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.