Provider Demographics
NPI:1467137521
Name:WIRED TO BLOOM THERAPY & CONSULTING, LLC
Entity Type:Organization
Organization Name:WIRED TO BLOOM THERAPY & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MACHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S, RPT-S
Authorized Official - Phone:513-679-1571
Mailing Address - Street 1:1327 E KEMPER RD STE 3100A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3945
Mailing Address - Country:US
Mailing Address - Phone:513-935-1993
Mailing Address - Fax:
Practice Address - Street 1:1327 E KEMPER RD STE 3100A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3945
Practice Address - Country:US
Practice Address - Phone:513-935-1993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty