NPIMap

Organization Active NPI

Neurobloom Counseling and Neurofeedback, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Broomfield, CO
National Provider Identifier
1912592452
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
NEUROBLOOM COUNSELING AND NEUROFEEDBACK, LLC
Practice address
13654 Xavier LN Ste 201
Broomfield, CO 80023-3608
Phone
(720) 523-1067
NPI assigned
Mar 6, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Tanja Gorenc, LMFTNPI 1629422662
Title
Licensed Marriage and Family Therap
Phone
(720) 523-1067

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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

13654 Xavier LN Ste 201
Broomfield, CO 80023-3608

Mailing address

13654 Xavier LN Ste 201
Broomfield, CO 80023-3608
Phone (720) 523-1067

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240504000361 CO Part B Supplier - Clinic/Group Practice 0345680500 Receives reassigned benefits from 6 practitioners
Practice locations: Broomfield, CO; Westminster, CO

National Provider Directory

National Provider Directory
Tax ID family
Neurobloom Counseling and Neurofeedback LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

80 Garden Ctr
Ste 137
Broomfield, CO 80020
Phone (720) 557-6978

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1614988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1912592452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13654 XAVIER LN STE 201",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800233608",
            "telephone_number": "720-523-1067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13654 XAVIER LN STE 201",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800233608",
            "telephone_number": "720-523-1067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROBLOOM COUNSELING AND NEUROFEEDBACK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-06",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "GORENC",
        "authorized_official_first_name": "TANJA",
        "authorized_official_title_or_position": "LICENSED MARRIAGE AND FAMILY THERAP",
        "authorized_official_telephone_number": "720-523-1067",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broomfield, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.