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General NPI Number Information
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NPI Number | 1457137069
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Entity Type | Organization
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Legal Business Name | CHERRY BLOSSOM HOLISTIC COUNSELING
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 1910 ST. JOE CENTER ROAD UNIT 64
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City | FORT WAYNE
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State | IN
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Zip | 46825-5000
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Country | US
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Telephone | 260-222-7516
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Fax |
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Provider Business Mailing Address
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Address Line | 2119 CALIFORNIA AVE
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City | FORT WAYNE
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State | IN
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Zip | 46805-4450
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Country | US
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Telephone | 260-222-7515
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Fax |
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Authorized Official
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Title or Position | LICENSED COUNSELOR
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Name | MS. KIMBERLY DAWN SCHENKE
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Credential | LMHC
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Telephone | 260-222-7516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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