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General NPI Number Information
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NPI Number | 1992572952
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Entity Type | Organization
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Legal Business Name | BLOOMING THERAPY LLC
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Dates
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Enumeration Date | 12/08/2023
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 21645 HIGHVIEW ST
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City | CLINTON TWP
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State | MI
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Zip | 48036-3736
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Country | US
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Telephone | 586-438-6411
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Fax |
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Provider Business Mailing Address
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Address Line | 21645 HIGHVIEW ST
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City | CLINTON TWP
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State | MI
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Zip | 48036-3736
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Country | US
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Telephone | 586-438-6411
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BRIAN MENDOZA
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Credential |
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Telephone | 630-632-5822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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