Healthcare Provider Details

I. General information

NPI: 1376456822
Provider Name (Legal Business Name): MINDFUL BLOSSOM COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4289 GARDNER AVE
BERKLEY MI
48072-1485
US

IV. Provider business mailing address

14370 PENROD ST
DETROIT MI
48223-3550
US

V. Phone/Fax

Practice location:
  • Phone: 586-805-0655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LIALA MARYANN REECE
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MA, LPC, NCC
Phone: 586-805-0655