Provider Demographics
NPI:1851163083
Name:FLOURISH MEDICAL AND BEHAVIORAL HEALTH GROUP, PLLC
Entity Type:Organization
Organization Name:FLOURISH MEDICAL AND BEHAVIORAL HEALTH GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:TYONNE
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-627-8748
Mailing Address - Street 1:PO BOX 10713
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28404-0713
Mailing Address - Country:US
Mailing Address - Phone:910-508-9885
Mailing Address - Fax:
Practice Address - Street 1:902 S COLLEGE RD STE 906
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4412
Practice Address - Country:US
Practice Address - Phone:910-508-9885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty