Provider Demographics
NPI:1457137069
Name:CHERRY BLOSSOM HOLISTIC COUNSELING
Entity Type:Organization
Organization Name:CHERRY BLOSSOM HOLISTIC COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:SCHENKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:260-222-7516
Mailing Address - Street 1:2119 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4450
Mailing Address - Country:US
Mailing Address - Phone:260-222-7515
Mailing Address - Fax:
Practice Address - Street 1:1910 ST. JOE CENTER ROAD
Practice Address - Street 2:UNIT 64
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5000
Practice Address - Country:US
Practice Address - Phone:260-222-7516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health