MEDICARE: SPIRIT IN BLOOM, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	14534	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992152862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPIRIT IN BLOOM, LLC

Provider Business Mailing Address
First Line	:	5874 BLACKSHIRE PATH
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1621
Country	:	US
Telephone Number	:	612-239-6262
Fax Number	:	651-774-9576

Provider Business Practice Location Address
First Line	:	5874 BLACKSHIRE PATH
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1621
Country	:	US
Telephone Number	:	612-239-6262
Fax Number	:	651-774-9576

Authorized Official
Title or Position	:	OWNER/MENTAL HEALTH THERAPIST
Name	:	TINA MARIE GOESS
Credential	:	LICSW
Telephone Number	:	612-239-6262

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	09/09/2025

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Directions to “SPIRIT IN BLOOM, LLC ” Practice Location

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