| Organization Name: | COLLABORATIVE COUNSELING CENTER |
| NPI Number: | 1528303823 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CASSIA LEA BLOOM (MARRIAGE FAMILY THERAPIST/ OWNER) |
| Mailing Address: | 6001 Butler Ln Ste 206 Scotts Valley |
| State: | CA US |
| Postal Code: | 950663550 |
| Phone Number: | 8315888032 |
| Fax Number: | 8314409016 |
| NPI Enumeration Date: | 11/28/2012 |
| NPI Last Update Date: | 11/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 28615 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |