=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356250302
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RADIANT BLOOM THERAPYY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2026
-----------------------------------------------------
Last Update Date | 09/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3001 W BELTLINE HWY STE 204
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53713-2832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-395-6182
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 827 BLUE CRANE RUN
-----------------------------------------------------
City | VERONA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53593-9187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-395-6182
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LPC, LMHC
-----------------------------------------------------
Name | ANASTASIA S HOLLAND
-----------------------------------------------------
Credential | LPC, LMHC
-----------------------------------------------------
Telephone | 347-395-6182
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------