Amber Dawn Bloom, LPC-S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

91735 Issued in TX

Practice address

1412 W Magnolia Ave Ste 210
Fort Worth, TX 76104-4364

Phone

(855) 914-5753

NPI assigned

Mar 14, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Thrive Counseling LLC

  • Mental Health Counselor
  • Lynchburg, VA
  • NPI 1215181300
  NPD

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

{
    "created_epoch": "1457913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1588025951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 E CHURCHVILLE RD",
            "address_2": "STE 300",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210143442",
            "telephone_number": "410-893-4600",
            "fax_number": "443-640-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 W MAGNOLIA AVE STE 210",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044364",
            "telephone_number": "855-914-5753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "AMBER",
        "middle_name": "DAWN",
        "name_prefix": "Ms.",
        "credential": "LPC-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-14",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "91735",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Duffy Bloemendal, OTR
• Lee Charles Bloemendal, MD
• Lee Scott Bloemendal, MD
• Bloom Bilingual Speech Therapy
• Bloom Harbor Collective, PLLC
• Tyler Lee Bloomer, M.D.
• Becky Bloomfield, PT
• Elizabeth M Bloomfield, PA
• Amy Joy Blount
• Blue Agave Solutions

• Professional Counselor in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.