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General NPI Number Information
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NPI Number | 1629440425
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Entity Type | Organization
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Legal Business Name | BLOOMING CONSULTANTS, PLLC
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 5969 LAIRD LAKE RD
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City | HALE
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State | MI
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Zip | 48739-9166
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Country | US
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Telephone | 989-728-2364
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Fax |
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Provider Business Mailing Address
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Address Line | 5969 LAIRD LAKE RD
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City | HALE
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State | MI
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Zip | 48739-9166
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Country | US
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Telephone | 989-728-2364
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED PROFESSIONAL COUNSEL
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Name | ANNMARIE SHAY
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Credential | MA, LPC
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Telephone | 989-728-2364
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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 | 6401013153
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License Number State | MI
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