Healthcare Provider Details

I. General information

NPI: 1023059839
Provider Name (Legal Business Name): BLOOMING HEARTS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 N ORACLE RD SUITE 110
TUCSON AZ
85704-5676
US

IV. Provider business mailing address

6160 N PASEO ZALDIVAR
TUCSON AZ
85750-1294
US

V. Phone/Fax

Practice location:
  • Phone: 520-481-9629
  • Fax:
Mailing address:
  • Phone: 520-797-0521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC 10390
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC 12100
License Number StateAZ

VIII. Authorized Official

Name: MRS. ROBIN MIMNA KNAPIK
Title or Position: COUNSELOR
Credential: LPC, LISAC, MA
Phone: 520-481-9629