MEDICARE: EVERBLOOMING PSYCHOTHERAPY AND WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1013712728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERBLOOMING PSYCHOTHERAPY AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	1420 OAKBROOK E
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-1126
Country	:	US
Telephone Number	:	517-930-3323
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 OAKBROOK E
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-1126
Country	:	US
Telephone Number	:	517-930-3323
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR/PSYCHOTHERAPIST
Name	:	TORI ANDREWS
Credential	:
Telephone Number	:	517-930-3323

Provider Enumeration Date	:	02/17/2025
Last Update Date	:	02/17/2025

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