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General NPI Number Information
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NPI Number | 1376456822
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Entity Type | Organization
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Legal Business Name | MINDFUL BLOSSOM COUNSELING LLC
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 4289 GARDNER AVE
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City | BERKLEY
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State | MI
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Zip | 48072-1485
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Country | US
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Telephone | 586-805-0655
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Fax |
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Provider Business Mailing Address
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Address Line | 14370 PENROD ST
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City | DETROIT
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State | MI
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Zip | 48223-3550
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | LIALA MARYANN REECE
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Credential | MA, LPC, NCC
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Telephone | 586-805-0655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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