Bloom Psychology SP LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

BLOOM PSYCHOLOGY SP LLC

Practice address

10100 Lantern Rd Ste 125
Fishers, IN 46037-7806

Phone

(317) 775-3942

Fax

(317) 775-3942

NPI assigned

Mar 13, 2024

Organization subpart

No

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

Authorized official

Name

Gretchen Haist

Title

Practice Manager

Phone

(317) 775-3942

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1710288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710288000000",
    "number": "1225896285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10100 LANTERN RD STE 125",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460377806",
            "telephone_number": "317-775-3942",
            "fax_number": "317-775-3942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10100 LANTERN RD STE 125",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460377806",
            "telephone_number": "317-775-3942",
            "fax_number": "317-775-3942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM PSYCHOLOGY SP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-13",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A",
        "authorized_official_last_name": "HAIST",
        "authorized_official_first_name": "GRETCHEN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "317-775-3942"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; 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.