Provider Demographics
NPI:1295202042
Name:BLOOMING MINDS. PLLC.
Entity Type:Organization
Organization Name:BLOOMING MINDS. PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:RASCHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAKIR
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW,MSW,MBA
Authorized Official - Phone:313-903-1737
Mailing Address - Street 1:1001 WOODWARD AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-1904
Mailing Address - Country:US
Mailing Address - Phone:313-903-1737
Mailing Address - Fax:
Practice Address - Street 1:1001 WOODWARD AVE FL 5
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-1904
Practice Address - Country:US
Practice Address - Phone:313-903-1737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)