Provider Demographics
NPI:1235650763
Name:BLOSSOMING INSIGHT COUNSELING AND SUPERVISION SERVICES LLC
Entity Type:Organization
Organization Name:BLOSSOMING INSIGHT COUNSELING AND SUPERVISION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PALUSKAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:734-556-2708
Mailing Address - Street 1:28476 BARBARA LN
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-2001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28476 BARBARA LN
Practice Address - Street 2:
Practice Address - City:GROSSE ILE
Practice Address - State:MI
Practice Address - Zip Code:48138-2001
Practice Address - Country:US
Practice Address - Phone:734-556-2708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016031101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401016031OtherLICENSE