Healthcare Provider Details

I. General information

NPI: 1518614965
Provider Name (Legal Business Name): MINDFUL BLOOM COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2022
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 S GILBERT RD STE 200
GILBERT AZ
85296-3438
US

IV. Provider business mailing address

1090 S GILBERT RD STE 200
GILBERT AZ
85296-3438
US

V. Phone/Fax

Practice location:
  • Phone: 480-504-9123
  • Fax:
Mailing address:
  • Phone: 480-504-9123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ERICA CHRISTMAS
Title or Position: OWNER
Credential: LPC
Phone: 480-504-9123