Healthcare Provider Details

I. General information

NPI: 1073433389
Provider Name (Legal Business Name): BLOSSOM THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 08/09/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3618 CANYON LAKE DR STE 107
RAPID CITY SD
57702-3129
US

IV. Provider business mailing address

3213 W MAIN ST # 259
RAPID CITY SD
57702-2314
US

V. Phone/Fax

Practice location:
  • Phone: 605-608-2255
  • Fax:
Mailing address:
  • Phone: 605-608-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CARLA STARR
Title or Position: THERAPIST/OWNER
Credential: MSW
Phone: 605-608-2255