Healthcare Provider Details

I. General information

NPI: 1225881949
Provider Name (Legal Business Name): HEAL & BLOOM THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 OKEMOS RD STE C
OKEMOS MI
48864-3285
US

IV. Provider business mailing address

5487 MAPLE RDG
HASLETT MI
48840-8651
US

V. Phone/Fax

Practice location:
  • Phone: 517-212-4044
  • Fax:
Mailing address:
  • Phone: 517-719-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MEGAN L ALLISON
Title or Position: OWNER/THERAPIST
Credential: LMSW
Phone: 517-719-8899