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General NPI Number Information
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NPI Number | 1881433191
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Entity Type | Organization
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Legal Business Name | MINDS THAT BLOOM LLC
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 105 FRONT ST STE 202
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City | BEREA
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State | OH
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Zip | 44017-1983
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Country | US
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Telephone | 216-200-6546
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Fax | 440-848-1897
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Provider Business Mailing Address
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Address Line | 105 FRONT ST STE 202
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City | BEREA
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State | OH
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Zip | 44017-1983
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Country | US
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Telephone | 216-200-6546
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Fax | 440-848-1897
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | MARRANDA ANN BENNETT
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Credential | M. ED. LPCC
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Telephone | 216-200-6546
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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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