Healthcare Provider Details

I. General information

NPI: 1235029117
Provider Name (Legal Business Name): CLEMATIS BLOOM THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W KIRKWOOD AVE STE 232
BLOOMINGTON IN
47404-6134
US

IV. Provider business mailing address

101 W KIRKWOOD AVE STE 232
BLOOMINGTON IN
47404-6134
US

V. Phone/Fax

Practice location:
  • Phone: 812-821-3337
  • Fax: 812-214-1519
Mailing address:
  • Phone: 812-821-3337
  • Fax: 812-214-1519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANA MARIA MCLAMB
Title or Position: DIRECTOR/THERAPIST
Credential: LMHC
Phone: 269-220-2715