Provider Demographics
NPI:1174217392
Name:BLOOM, CHLOE MARIE (PCLC)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:MARIE
Last Name:BLOOM
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:CHLOE
Other - Middle Name:MARIE
Other - Last Name:BLEVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCLC
Mailing Address - Street 1:601 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2510
Mailing Address - Country:US
Mailing Address - Phone:406-454-6973
Mailing Address - Fax:406-791-9277
Practice Address - Street 1:228 17TH AVE NW
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1807
Practice Address - Country:US
Practice Address - Phone:406-454-6973
Practice Address - Fax:406-791-9277
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-62428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional