NPI Code Detail JSON Logo

1942169040 NPI number — THE BLOSSOM COUNSELING CENTER FOR PERSONAL GROWTH AND DEVELOPMENT LLC

NPI Number: 1942169040
Health Care Provider/Practitioner: THE BLOSSOM COUNSELING CENTER FOR PERSONAL GROWTH AND DEVELOPMENT LLC

Information about “1942169040” NPI (THE BLOSSOM COUNSELING CENTER FOR PERSONAL GROWTH AND DEVELOPMENT LLC) exists in 1942169040 in HTML format HTML  |  1942169040 in plain Text format TXT  |  1942169040 in PDF (Portable Document Format) PDF  |  1942169040 in an XML format XML  formats.

NPI Number : 1942169040 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942169040",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "THE BLOSSOM COUNSELING CENTER FOR PERSONAL GROWTH AND DEVELOPMENT LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5110 28TH ST SE # 1145",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GRAND RAPIDS",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49512-2049",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "616-284-1138",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4829 E BELTLINE AVE NE STE 101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GRAND RAPIDS",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49525-9349",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "616-284-1138",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/15/2026",
    "LastUpdateDate": "01/15/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MCNICHOLS",
    "AuthorizedOfficialFirstName": "SHAYNE",
    "AuthorizedOfficialMiddleName": "DELANA",
    "AuthorizedOfficialTitle": "THERAPIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LMSW",
    "AuthorizedOfficialTelephoneNumber": "616-284-1138",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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