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General NPI Number Information
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NPI Number | 1255278313
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Entity Type | Organization
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Legal Business Name | ANCHOR AND BLOOM THERAPY PLLC
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Dates
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Enumeration Date | 04/29/2026
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Last Update Date | 04/29/2026
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Provider Practice Location Address
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Address Line | 4255 PHEASANT RIDGE DR NE STE 412
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City | BLAINE
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State | MN
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Zip | 55449-5066
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Country | US
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Telephone | 612-384-3472
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Fax |
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Provider Business Mailing Address
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Address Line | 12263 XYLITE ST NE UNIT D
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City | BLAINE
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State | MN
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Zip | 55449-5291
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Country | US
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Telephone | 612-384-3472
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Fax |
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Authorized Official
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Title or Position | OWNER/MARRIAGE AND FAMILY THERAPIST
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Name | MR. VLADIMIR GORDEYEV
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Credential | MS, LMFT
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Telephone | 612-384-3472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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