Provider Demographics
NPI:1013646090
Name:BLOSSOM WITHIN THERAPY,LLC
Entity Type:Organization
Organization Name:BLOSSOM WITHIN THERAPY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:CARRANZA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:808-841-5676
Mailing Address - Street 1:95-227 WAIKALANI DR APT A905
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3539
Mailing Address - Country:US
Mailing Address - Phone:206-473-9732
Mailing Address - Fax:
Practice Address - Street 1:95-227 WAIKALANI DR APT A905
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-3539
Practice Address - Country:US
Practice Address - Phone:206-473-9732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)