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General NPI Number Information
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NPI Number | 1235029117
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Entity Type | Organization
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Legal Business Name | CLEMATIS BLOOM THERAPY LLC
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 101 W KIRKWOOD AVE STE 232
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City | BLOOMINGTON
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State | IN
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Zip | 47404-6134
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Country | US
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Telephone | 812-821-3337
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Fax | 812-214-1519
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Provider Business Mailing Address
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Address Line | 101 W KIRKWOOD AVE STE 232
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City | BLOOMINGTON
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State | IN
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Zip | 47404-6134
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Country | US
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Telephone | 812-821-3337
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Fax | 812-214-1519
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Authorized Official
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Title or Position | DIRECTOR/THERAPIST
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Name | ANA MARIA MCLAMB
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Credential | LMHC
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Telephone | 269-220-2715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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