Healthcare Provider Details

I. General information

NPI: 1235650763
Provider Name (Legal Business Name): BLOSSOMING INSIGHT COUNSELING AND SUPERVISION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 W JEFFERSON AVE STE 209
TRENTON MI
48183-0139
US

IV. Provider business mailing address

28476 BARBARA LN
GROSSE ILE MI
48138-2001
US

V. Phone/Fax

Practice location:
  • Phone: 734-556-2708
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016031
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGEL PALUSKAS
Title or Position: OWNER
Credential: LPC
Phone: 734-556-2708