Provider Demographics
NPI:1558055152
Name:BLOOMING CLEMATIS THERAPY & CONSULTING LLC
Entity Type:Organization
Organization Name:BLOOMING CLEMATIS THERAPY & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIALING
Authorized Official - Phone:602-609-5255
Mailing Address - Street 1:PO BOX 8130
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-8130
Mailing Address - Country:US
Mailing Address - Phone:480-340-1236
Mailing Address - Fax:
Practice Address - Street 1:2214 W LOS ARBOLES PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2143
Practice Address - Country:US
Practice Address - Phone:480-340-1236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty