NPIMap

Organization Active NPI

Bloom Therapy, PLLC

Doing business as Bloom Therapy

  • Professional Counselor
  • Austin, TX
National Provider Identifier
1649677006
Registry record updated Jan 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
69652 Issued in TX
Legal business name
BLOOM THERAPY, PLLC
Doing business as
Bloom Therapy
Practice address
1205 W 43Rd St
Austin, TX 78756-3301
Phone
(512) 660-9611
Fax
(512) 220-1075
NPI assigned
Dec 1, 2014
Last updated
Jan 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2023

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

Authorized official

Name
Ms. Katy David, LPC-SNPI 1881092807
Title
Clinical Director/Supervisor
Phone
(512) 660-9611

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 Counselor 101YP2500X 69652 TX Primary

Addresses

Primary practice location

1205 W 43Rd St
Austin, TX 78756-3301

Mailing address

1205 W 43Rd St
Austin, TX 78756-3301
Phone (512) 660-9611

Other practice location 1

1206 W 43rd St
Austin, TX 78756-3302
Phone (512) 660-9611

Other names 1

  • Bloom Therapy Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address katy@bloomtherapytx.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240423001235 TX Part B Supplier - Clinic/Group Practice 2365881455 Receives reassigned benefits from 3 practitioners
Practice locations: Austin, TX

National Provider Directory

National Provider Directory

Locations

1205 W 43rd St
Austin, TX 78756
Phone (512) 200-3017

1206 W 43rd St
Austin, TX 78756
Phone (512) 522-2810

4131 Spicewood Springs Rd
Ste I7
Austin, TX 78759
Phone (512) 758-6800

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1417392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672704000000",
    "number": "1649677006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 W 43RD ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787563301",
            "telephone_number": "512-660-9611",
            "fax_number": "512-220-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 W 43RD ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787563301",
            "telephone_number": "512-660-9611",
            "fax_number": "512-220-1075"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1206 W 43rd St",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787563302",
            "country_code": "US",
            "telephone_number": "512-660-9611",
            "fax_number": "512-220-1075",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLOOM THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-01",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A",
        "authorized_official_last_name": "DAVID",
        "authorized_official_first_name": "KATY",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR/SUPERVISOR",
        "authorized_official_telephone_number": "512-660-9611",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC-S"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "69652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "katy@bloomtherapytx.com",
            "affiliation": "N",
            "endpointDescription": "encrypted professional email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1206 W 43rd St",
            "city": "Austin",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787563302",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Bloom Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; 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.