Provider Demographics
NPI:1952840597
Name:BLOSSOMING BRAINS PLLC
Entity Type:Organization
Organization Name:BLOSSOMING BRAINS PLLC
Other - Org Name:BLOSSOMING BRAINS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:CAREY GRAHOVEC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-385-8001
Mailing Address - Street 1:5000 ELDORADO PKWY
Mailing Address - Street 2:BOX 555
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-8695
Mailing Address - Country:US
Mailing Address - Phone:214-385-8001
Mailing Address - Fax:
Practice Address - Street 1:11955 DALLAS PKWY
Practice Address - Street 2:#400
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4293
Practice Address - Country:US
Practice Address - Phone:214-385-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37229103G00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty