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General NPI Number Information
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NPI Number | 1073491601
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Entity Type | Organization
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Legal Business Name | WHOLENESS IN BLOOM, LLC
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Dates
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Enumeration Date | 08/22/2025
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 116 AGNES RD STE 200
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City | KNOXVILLE
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State | TN
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Zip | 37919-6306
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Country | US
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Telephone | 615-601-0368
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Fax |
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Provider Business Mailing Address
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Address Line | 299 BLUE LAKE CIR
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City | ANTIOCH
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State | TN
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Zip | 37013-3784
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Country | US
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Telephone | 615-573-7597
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MONICA JHA
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Credential | LPC-MHSP
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Telephone | 615-601-0368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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