Healthcare Provider Details

I. General information

NPI: 1992152862
Provider Name (Legal Business Name): SPIRIT IN BLOOM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5874 BLACKSHIRE PATH
INVER GROVE HEIGHTS MN
55076-1621
US

IV. Provider business mailing address

5874 BLACKSHIRE PATH
INVER GROVE HEIGHTS MN
55076-1621
US

V. Phone/Fax

Practice location:
  • Phone: 612-239-6262
  • Fax: 651-774-9576
Mailing address:
  • Phone: 612-239-6262
  • Fax: 651-774-9576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number14534
License Number StateMN

VIII. Authorized Official

Name: TINA MARIE GOESS
Title or Position: OWNER/MENTAL HEALTH THERAPIST
Credential: LICSW
Phone: 612-239-6262