Provider Demographics
NPI:1497520449
Name:FOREVER BLOOMING THERAPY PLLC
Entity Type:Organization
Organization Name:FOREVER BLOOMING THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTERS LEVEL CLINICAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-369-1869
Mailing Address - Street 1:7912 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8955
Mailing Address - Country:US
Mailing Address - Phone:269-369-1869
Mailing Address - Fax:
Practice Address - Street 1:7912 S 8TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8955
Practice Address - Country:US
Practice Address - Phone:269-369-1869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty