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General NPI Number Information
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NPI Number | 1992152862
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Entity Type | Organization
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Legal Business Name | SPIRIT IN BLOOM, LLC
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Dates
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Enumeration Date | 05/19/2016
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 5874 BLACKSHIRE PATH
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-1621
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Country | US
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Telephone | 612-239-6262
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Fax | 651-774-9576
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Provider Business Mailing Address
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Address Line | 5874 BLACKSHIRE PATH
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-1621
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Country | US
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Telephone | 612-239-6262
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Fax | 651-774-9576
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Authorized Official
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Title or Position | OWNER/MENTAL HEALTH THERAPIST
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Name | TINA MARIE GOESS
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Credential | LICSW
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Telephone | 612-239-6262
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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 | 14534
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License Number State | MN
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