Provider Demographics
NPI:1477362192
Name:BLOOM & THRIVE WELLNESS, LLC
Entity type:Organization
Organization Name:BLOOM & THRIVE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDUC
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISW-S, LICDC
Authorized Official - Phone:419-665-1277
Mailing Address - Street 1:1331 CONANT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-4214
Mailing Address - Country:US
Mailing Address - Phone:419-665-1277
Mailing Address - Fax:
Practice Address - Street 1:1331 CONANT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4214
Practice Address - Country:US
Practice Address - Phone:419-665-1277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty