MEDICARE: BLOSSOM WELLNESS PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1689555419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOSSOM WELLNESS PLLC

Provider Business Mailing Address
First Line	:	2020 N ACADEMY BLVD STE 261
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1514
Country	:	US
Telephone Number	:	252-349-0557
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 N ACADEMY BLVD STE 261
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1514
Country	:	US
Telephone Number	:	252-349-0557
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MEGAN GRAY
Credential	:	LCSW
Telephone Number	:	252-349-0557

Provider Enumeration Date	:	09/09/2025
Last Update Date	:	09/09/2025

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Directions to “BLOSSOM WELLNESS PLLC ” Practice Location

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