MEDICARE: BLOOMING MINDS THERAPY

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	:	1720923501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOMING MINDS THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 51934
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27717-1934
Country	:	US
Telephone Number	:	919-699-1611
Fax Number	:

Provider Business Practice Location Address
First Line	:	4613 CARLTON CROSSING DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-6503
Country	:	US
Telephone Number	:	919-699-1611
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAUREN C JONES
Credential	:	LCSW
Telephone Number	:	919-699-1611

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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Directions to “BLOOMING MINDS THERAPY ” Practice Location

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