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General NPI Number Information
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NPI Number | 1336692144
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Entity Type | Organization
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Legal Business Name | PEOPLE IN BLOOM PLC
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 525 S UNION ST STE B
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City | TRAVERSE CITY
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State | MI
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Zip | 49684
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Country | US
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Telephone | 231-492-3170
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Fax |
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Provider Business Mailing Address
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Address Line | 525 S UNION ST STE B
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-3246
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Country | US
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Telephone | 231-492-3170
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. KATHY M LANTZER
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Credential | LMSW
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Telephone | 231-632-0206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6801077025
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License Number State | MI
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