Healthcare Provider Details

I. General information

NPI: 1255278313
Provider Name (Legal Business Name): ANCHOR AND BLOOM THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 08/09/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 PHEASANT RIDGE DR NE STE 412
BLAINE MN
55449-5066
US

IV. Provider business mailing address

12263 XYLITE ST NE UNIT D
BLAINE MN
55449-5291
US

V. Phone/Fax

Practice location:
  • Phone: 612-384-3472
  • Fax:
Mailing address:
  • Phone: 612-384-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. VLADIMIR GORDEYEV
Title or Position: OWNER/MARRIAGE AND FAMILY THERAPIST
Credential: MS, LMFT
Phone: 612-384-3472