Provider Demographics
NPI:1689237281
Name:MINDS IN BLOOM
Entity Type:Organization
Organization Name:MINDS IN BLOOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SPITLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, BCBA
Authorized Official - Phone:630-404-6275
Mailing Address - Street 1:1240 S BIRCH ST APT 509
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-7832
Mailing Address - Country:US
Mailing Address - Phone:630-404-6275
Mailing Address - Fax:
Practice Address - Street 1:1240 S BIRCH ST APT 509
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-7832
Practice Address - Country:US
Practice Address - Phone:630-404-6275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty