Larissa Joelle Bloom, LASAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LASAC-15335 Issued in AZ

Practice address

483 W Seed Farm Rd
Sacaton, AZ 85147-5000

Phone

(602) 528-1200

NPI assigned

Mar 18, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1584489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584489600000",
    "number": "1568098846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36",
            "city": "SACATON",
            "state": "AZ",
            "postal_code": "851470001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "483 W SEED FARM RD",
            "city": "SACATON",
            "state": "AZ",
            "postal_code": "851475000",
            "telephone_number": "602-528-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "LARISSA",
        "middle_name": "JOELLE",
        "credential": "LASAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-18",
        "last_updated": "2020-03-18",
        "certification_date": "2020-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "LASAC-15335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meena Bhargava, PHARM. D.
• Brooke Lee Billings, FNP-C
• Evelyn Bird, RD
• Wendolyn Bitselley Calderon, FNP-C
• Joyce Mary Blair
• Ina Blue, LCSW
• Michael Bond, D.P.T.
• Shannon Yvonne Borrego, OD
• Renee Boudreau
• Cassi Bouton

• All providers in Sacaton, AZ
• Addiction (Substance Use Disorder) Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2020; 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.