Healthcare Provider Details

I. General information

NPI: 1669308789
Provider Name (Legal Business Name): BLOSSOM COUNSELING AND COACHING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHISHOLM TRAIL RD BLDG 1
ROUND ROCK TX
78681-5008
US

IV. Provider business mailing address

500 SCOOTER ST
GEORGETOWN TX
78626-3288
US

V. Phone/Fax

Practice location:
  • Phone: 214-444-9002
  • Fax:
Mailing address:
  • Phone: 469-834-0056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JING SHI
Title or Position: OWNER
Credential: LPC
Phone: 469-834-0056