Healthcare Provider Details

I. General information

NPI: 1841767290
Provider Name (Legal Business Name): BLOOMING LOTUS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9365 US HIGHWAY 19 N STE B
PINELLAS PARK FL
33782-5400
US

IV. Provider business mailing address

13801 WALSINGHAM RD UNIT 127
LARGO FL
33774-3237
US

V. Phone/Fax

Practice location:
  • Phone: 727-470-8003
  • Fax:
Mailing address:
  • Phone: 727-470-8003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE CAMPBELL
Title or Position: OWNER
Credential: LMHC
Phone: 727-470-8003