Provider Demographics
NPI:1659088425
Name:BLOOMING MINDS, INC
Entity Type:Organization
Organization Name:BLOOMING MINDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDOURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-442-2472
Mailing Address - Street 1:24307 MAGIC MOUNTAIN PKWY # 1090
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14668 WALNUT RD
Practice Address - Street 2:
Practice Address - City:SOLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3402
Practice Address - Country:US
Practice Address - Phone:310-667-2166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty