Provider Demographics
NPI:1558014589
Name:INFINITE BLOSSOM COUNSELING LLC
Entity Type:Organization
Organization Name:INFINITE BLOSSOM COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:REMY-VALEUS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:347-869-1746
Mailing Address - Street 1:500 WESTGATE DR # 1041
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1855
Mailing Address - Country:US
Mailing Address - Phone:508-290-0210
Mailing Address - Fax:
Practice Address - Street 1:500 WESTGATE DR # 1041
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1855
Practice Address - Country:US
Practice Address - Phone:508-290-0210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty