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General NPI Number Information
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NPI Number | 1770383358
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Entity Type | Organization
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Legal Business Name | MIND BLOOM FAMILY THERAPY, PROF. CORP.
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 7922 DAY CREEK BLVD APT 4318
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-8590
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Country | US
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Telephone | 909-459-9651
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Fax |
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Provider Business Mailing Address
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Address Line | 7922 DAY CREEK BLVD APT 4318
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-8590
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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 | OWNER
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Name | MICHELLE TAPIA
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Credential | LMFT
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Telephone | 909-459-9651
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 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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