Healthcare Provider Details

I. General information

NPI: 1255289559
Provider Name (Legal Business Name): BLOOMING OAK THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6111 HIGHWAY 2003
MC KEE KY
40447-7246
US

IV. Provider business mailing address

212 N 2ND ST STE 100
RICHMOND KY
40475-1408
US

V. Phone/Fax

Practice location:
  • Phone: 606-312-1560
  • Fax:
Mailing address:
  • Phone:
  • 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: KASSIDY MICHAELA CREECH
Title or Position: OWNER
Credential: LCSW
Phone: 606-312-1560