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General NPI Number Information
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NPI Number | 1669351037
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Entity Type | Organization
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Legal Business Name | MENTAL BLOOM THERAPY
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 632 N 2ND ST UNIT 1101
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City | PHILADELPHIA
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State | PA
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Zip | 19123-3033
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Country | US
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Telephone | 215-805-4212
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Fax |
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Provider Business Mailing Address
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Address Line | 632 N 2ND ST UNIT 1101
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City | PHILADELPHIA
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State | PA
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Zip | 19123-3033
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Country | US
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Telephone | 215-805-4212
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | ASHLEY LYNN
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Credential | LPC, LCDC
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Telephone | 215-720-1741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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