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General NPI Number Information
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NPI Number | 1679461032
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Entity Type | Organization
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Legal Business Name | MIND BLOOM
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 222 W GREGORY BLVD STE 310
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City | KANSAS CITY
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State | MO
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Zip | 64114-1127
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Country | US
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Telephone | 816-287-4166
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Fax |
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Provider Business Mailing Address
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Address Line | 4322 ROCKHILL RD
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City | KANSAS CITY
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State | MO
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Zip | 64110-1533
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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 | THERAPIST
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Name | EMILY DEFOE
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Credential | LCSW
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Telephone | 816-287-4166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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