Provider Demographics
NPI:1437633815
Name:BLUEFLAME ENTERPRISES, LLC
Entity Type:Organization
Organization Name:BLUEFLAME ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMERA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LPCC, MS, NCC
Authorized Official - Phone:801-755-0282
Mailing Address - Street 1:3202 SUMMERWIND CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2769
Mailing Address - Country:US
Mailing Address - Phone:801-755-0282
Mailing Address - Fax:
Practice Address - Street 1:2243 PARK AVE
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4216
Practice Address - Country:US
Practice Address - Phone:801-755-0282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0053FROtherBLUE CROSS BLUE SHEILD
NM23286351Medicaid
TX980872OtherBEACON HEALTH