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General NPI Number Information
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NPI Number | 1861081523
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Entity Type | Organization
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Legal Business Name | BLOSSOM FORWARD LLC
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 9521 SHELLIE RD STE 13
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City | JACKSONVILLE
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State | FL
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Zip | 32257-6174
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Country | US
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Telephone | 904-257-6835
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Fax |
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Provider Business Mailing Address
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Address Line | 7977 SWEET ROSE LN
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City | JACKSONVILLE
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State | FL
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Zip | 32244-6175
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Country | US
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Telephone | 904-327-7554
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Fax |
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Authorized Official
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Title or Position | CEO/LICENSED CLINICIAN
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Name | BRITTANY BEATTIE
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Credential | LMHC
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Telephone | 904-327-7554
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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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