Provider Demographics
NPI:1396319604
Name:MINDFUL BLOOM THERAPY LLC.
Entity type:Organization
Organization Name:MINDFUL BLOOM THERAPY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:724-689-9147
Mailing Address - Street 1:1118 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-4781
Mailing Address - Country:US
Mailing Address - Phone:724-689-9147
Mailing Address - Fax:
Practice Address - Street 1:150 ROBBINS STATION RD STE 8
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-2037
Practice Address - Country:US
Practice Address - Phone:724-689-9147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty