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BLOOM PSYCHIATRIC, LLC

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Company Details

Legal Name: BLOOM PSYCHIATRIC, LLC
Jurisdiction: WASHINGTON
Entity Type: WA LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Voluntarily Dissolved
Formation/ Registration Date: May 10th 2021
Date of Dissolution: April 12th 2022
Expiration date: 31 May 2022
UBI Number: 604 746 979
ZIP code: 98662
City: Vancouver
County: CLARK
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 4400 NE 77TH AVE STE 275, VANCOUVER, WA, 98662-6857, UNITED STATES

Contact Details

E-Mail: TTERRY@BLOOMPSYCHIATRIC.COM
Phone Number: +1 971-813-9093

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
CHARLES A ISLEY Registered Agent 205 E 11TH ST STE 102, VANCOUVER, WA, 98660-3309, UNITED STATES

Key Officers & Management

Name Role Address
BRANDON TERRY Executor 9507 NE 27TH AVE, VANCOUVER, WA, 98665-5804, UNITED STATES
TIFFANY TERRY Governing Person -

National Provider Identifier

NPI Number:
1023684024
Certification Date:
2021-06-01

Authorized Person:

Name:
TIFFANY TERRY
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
Yes

Contacts:

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