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General NPI Number Information
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NPI Number | 1588260319
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Entity Type | Organization
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Legal Business Name | WALLFLOWERS BLOOM FAMILY THERAPY INC
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 25000 AVENUE STANFORD STE 240
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City | VALENCIA
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State | CA
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Zip | 91355-4598
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Country | US
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Telephone | 818-414-8507
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Fax |
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Provider Business Mailing Address
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Address Line | 13883 GARBER ST
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City | ARLETA
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State | CA
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Zip | 91331-5431
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Country | US
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Telephone | 818-414-8507
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | NICOLE SEGROVES
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Credential |
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Telephone | 661-874-7851
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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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