Provider Demographics
NPI:1164105821
Name:BLOOMING MAGNOLIAS THERAPY, LLC
Entity Type:Organization
Organization Name:BLOOMING MAGNOLIAS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:419-406-4780
Mailing Address - Street 1:842 W SOUTH BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5265
Mailing Address - Country:US
Mailing Address - Phone:419-406-4780
Mailing Address - Fax:
Practice Address - Street 1:842 W SOUTH BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5265
Practice Address - Country:US
Practice Address - Phone:419-406-4780
Practice Address - Fax:419-458-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty