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General NPI Number Information
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NPI Number | 1699554006
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Entity Type | Organization
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Legal Business Name | BLOSSOM SERVICES, PLLC
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 25 CLYDEAN DR
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City | LEBURN
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State | KY
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Zip | 41831-8702
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Country | US
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Telephone | 606-216-5431
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Fax |
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Provider Business Mailing Address
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Address Line | 1192 PIGEONROOST RD
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City | BULAN
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State | KY
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Zip | 41722-9027
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Country | US
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Telephone | 606-216-5431
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEFFREY COMBS
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Credential | LPCC-S
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Telephone | 606-216-5431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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