=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134793094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE IN FULL BLOOM COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2021
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 WESTHALL LN STE 133
-----------------------------------------------------
City | MAITLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32751-4195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-513-2589
-----------------------------------------------------
Fax | 407-637-2823
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 WESTHALL LN STE 133
-----------------------------------------------------
City | MAITLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32751-4195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-513-2589
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LMHC
-----------------------------------------------------
Name | ASHLEY VALENCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-513-2589
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------