LARISSA JOELLE BLOOM (NPI# 1568098846) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568098846 |
| Entity Type | Individual |
| Full Name | LARISSA JOELLE BLOOM |
| Credential | LASAC |
| Practice Address |
483 W Seed Farm Rd Sacaton AZ 85147-5000 |
| Mailing Address |
Po Box 36 Sacaton AZ 85147-0001 |
| Practice Telephone | 6025281200 |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2020-03-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
LASAC-15335 | AZ | Behavioral Health & Social Service Providers |
| Street Address |
483 W SEED FARM RD |
| City | SACATON |
| State | AZ |
| Zip Code | 85147-5000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649266883 | Karin B Fisk | Nurse Practitioner | 483 W Seed Farm Rd, Sacaton, AZ 85147-5000 | 2005-09-22 |
| 1639786890 | Juliandra Bailon | Counselor | 483 W Seed Farm Rd, Sacaton, AZ 85147-5000 | 2020-09-30 |
| 1922624535 | Joyce Mary Blair | Counselor | 483 W Seed Farm Rd, Sacaton, AZ 85147-5000 | 2020-06-19 |
| 1881219095 | Olivia Rae Hoylman | Optometrist | 483 W Seed Farm Rd, Sacaton, AZ 85147-5000 | 2020-06-12 |
| 1225652050 | Sarah David | Optometrist | 483 W Seed Farm Rd, Sacaton, AZ 85147-5000 | 2020-06-08 |
| 1962026906 | Candace Wilson | Social Worker | 483 W Seed Farm Rd, Sacaton, AZ 85147-5000 | 2020-06-05 |
| 1154943678 | Joni Delaney | Counselor | 483 W Seed Farm Rd, Sacaton, AZ 85147-5000 | 2020-05-07 |
| 1700406808 | Clara Terrazas | Social Worker | 483 W Seed Farm Rd, Sacaton, AZ 85147-5000 | 2020-04-20 |
| 1326676958 | Debra Lee Cockrell | Counselor | 483 W Seed Farm Rd, Sacaton, AZ 85147-5000 | 2020-03-30 |
| 1295362101 | Adriane Miles | Counselor | 483 W Seed Farm Rd, Sacaton, AZ 85147-5000 | 2020-03-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104452507 | Jeremy James Pumphrey | Counselor | 438 W Seed Farm Rd, Sacaton, AZ 85147 | 2020-03-17 |
| 1215563804 | Leo Oswaldo Merino | Counselor | 291 W. Casa Blanca Rd. Bldg. # 7, Sacaton, AZ 85147 | 2020-03-16 |
| 1588166896 | Stephanie Lashawn Brown | Social Worker | 483 West Seed Farm Rd., Sacaton, AZ 85147 | 2018-03-02 |
| 1255602447 | Joyce Mildred Villalobos | Counselor | Gila River Health Care Corp, 483 W Seed Farm Rd, Sacaton, AZ 85147 | 2012-01-19 |
| 1417237074 | Gila River Health Care | Community/Behavioral Health | 291 W Casa Blanca Rd, Sacaton, AZ 85147 | 2011-08-26 |
| 1750598322 | Kari Beth Harris | Social Worker | 198 South Skill Center Road, Sacaton, AZ 85147 | 2007-05-16 |
| 1740378694 | Vincent Anthony Berkley | Internal Medicine | 198 S. Skill Center Road, Sacaton, AZ 85147 | 2006-10-10 |
| 1568448801 | Wesley Neil Yamada | Podiatrist | 483 W Seed Farm Road, Sacaton, AZ 85147 | 2005-12-19 |
| 1376532515 | Frances Antone | Physician Assistant | 483 W Seed Farm Rd., Sacaton, AZ 85147 | 2005-10-20 |
| 1538167051 | Xuong Wilkinson | Family Medicine | 483 West Seed Farm Road, Sacaton, AZ 85147 | 2005-07-08 |
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| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255602447 | Joyce Mildred Villalobos | Counselor | Gila River Health Care Corp, 483 W Seed Farm Rd, Sacaton, AZ 85147 | 2012-01-19 |
| 1447428206 | Janet M Carpentier | Counselor | 483 W Seedfarm Road, New Beginnings Bldg, Sacaton, AZ 85247 | 2008-02-14 |
| 1619155256 | Sharon J. Downer | Counselor | 483 W. Seedfarm Rd., Hu Hu Kam Memorial Hospital, Sacaton, AZ 85247-0038 | 2008-02-06 |
| 1508044223 | Ted Whitney Allison | Counselor | 483 Seed Farm Road, Sacaton, AZ 85247 | 2008-02-05 |
| 1851579585 | William Dale Bradford | Counselor | 483 West Seedfarm Road, Sacaton, AZ 85247-0038 | 2008-02-05 |
| 1639786890 | Juliandra Bailon | Counselor | 483 W Seed Farm Rd, Sacaton, AZ 85147-5000 | 2020-09-30 |
| 1518580158 | Charlie Ginn | Counselor | 291 W Casa Blanca Rd, Sacaton, AZ 85147 | 2020-05-18 |
| 1912366980 | Rosalinda Sigarroba | Counselor | 483 W. Seed Farm Rd., Sacaton, AZ 85147 | 2016-02-18 |
| 1447619523 | Manny Athans | Counselor | 483 W. Seed Farm Rd., Sacaton, AZ 85147 | 2016-02-17 |
| 1336508415 | Hazel Long | Counselor | 483 W. Seed Farm Rd., Sacaton, AZ 85147-0001 | 2016-02-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.