Healthcare Provider Details

I. General information

NPI: 1104754605
Provider Name (Legal Business Name): NEEMABLOOM THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 WILSHIRE BLVD STE 1210
LOS ANGELES CA
90036-3710
US

IV. Provider business mailing address

3806 LORADO WAY 3806 LORADO WAY
VIEW PARK CA
90043-1626
US

V. Phone/Fax

Practice location:
  • Phone: 323-489-0205
  • Fax:
Mailing address:
  • Phone: 323-489-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KELLY WALKER
Title or Position: OWNER/CEO
Credential: LCSW
Phone: 323-489-0205