MEDICARE: BLOSSOM COUNSELING AND COACHING 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1669308789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOSSOM COUNSELING AND COACHING LLC

Provider Business Mailing Address
First Line	:	500 SCOOTER ST
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-3288
Country	:	US
Telephone Number	:	469-834-0056
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CHISHOLM TRAIL RD BLDG 1
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5008
Country	:	US
Telephone Number	:	214-444-9002
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JING SHI
Credential	:	LPC
Telephone Number	:	469-834-0056

Provider Enumeration Date	:	06/18/2026
Last Update Date	:	06/18/2026

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