Healthcare Provider Details

I. General information

NPI: 1639937071
Provider Name (Legal Business Name): HOPE BLOOMS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E RUSSELL ST
RHOME TX
76078-4487
US

IV. Provider business mailing address

110 E HIGHWAY 82
NOCONA TX
76255-2721
US

V. Phone/Fax

Practice location:
  • Phone: 817-592-9248
  • Fax: 817-612-3455
Mailing address:
  • Phone: 469-556-3837
  • Fax: 817-612-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY FLEISCHER
Title or Position: THERAPIST/OWNER
Credential: LPC
Phone: 469-556-3837