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General NPI Number Information
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NPI Number | 1992577761
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Entity Type | Organization
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Legal Business Name | GROUND BLOOM PLLC
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 2520 SAINT ROSE PKWY STE 110
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City | HENDERSON
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State | NV
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Zip | 89074-7784
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Country | US
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Telephone | 702-326-8246
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Fax |
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Provider Business Mailing Address
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Address Line | 811 APPERSON CIR
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City | LAS VEGAS
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State | NV
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Zip | 89123-0543
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Country | US
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Telephone | 702-326-8246
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Fax |
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | RACHEL AGRARIO
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Credential | CPC
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Telephone | 702-326-8246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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