Provider Demographics
NPI:1225320476
Name:BLOSSOMING SEEDS
Entity Type:Organization
Organization Name:BLOSSOMING SEEDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:IBARRA-BRLETIC
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:407-949-2659
Mailing Address - Street 1:426 EAGLE CIR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-4821
Mailing Address - Country:US
Mailing Address - Phone:407-949-2659
Mailing Address - Fax:
Practice Address - Street 1:426 EAGLE CIR
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-4821
Practice Address - Country:US
Practice Address - Phone:407-949-2659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty