Bloom Recovery
Organization Active NPI Counselor · Salt Lake City, UT
NPI 1902339740 · NPPES record last updated Apr 8, 2017
Key facts
- NPI
- 1902339740
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Counselor 101Y00000X
- License
- 8922867-6004 (UT)
- Legal business name
- BLOOM RECOVERY
- Practice address
- 470 E 3900 S
Suite 101
Salt Lake City, UT 84107-1880 - Phone
- (801) 809-6011
- NPI assigned
- Apr 8, 2017
- Organization subpart
- No
Authorized official
- Name
- Mr. Alex F Runolfson, CMHC
- Title
- President
- Phone
- (801) 809-6011
Corporate family (same tax ID) 1
Practitioners 1
-
Alex Franklin Runolfson, CMHC
National Provider Directory
- Tax ID family
- Alex Franklin Runolfson
Locations
470 E 3900 S
Ste 101
Salt Lake City, UT 84107
Phone (801) 809-6011
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor |
101Y00000X | 8922867-6004 | UT | Yes |
Addresses
Primary practice location
470 E 3900 S
Suite 101
Salt Lake City, UT 84107-1880
Mailing address
2220 E Murray Holladay Rd
Unit 186
Holladay, UT 84117-5377
Phone (801) 809-6011
Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.