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General NPI Number Information
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NPI Number | 1952840597
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Entity Type | Organization
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Legal Business Name | BLOSSOMING BRAINS PLLC
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 11955 DALLAS PKWY #400
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City | FRISCO
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State | TX
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Zip | 75033-4293
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Country | US
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Telephone | 214-385-8001
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 ELDORADO PKWY BOX 555
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City | FRISCO
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State | TX
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Zip | 75033-8695
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Country | US
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Telephone | 214-385-8001
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MORGAN IRENE CAREY GRAHOVEC
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Credential | PH.D.
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Telephone | 214-385-8001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 37229
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 37229
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 37229
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License Number State | TX
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