Provider Demographics
NPI:1477386605
Name:BLOOMING HOPE COUNSELING PLLC
Entity type:Organization
Organization Name:BLOOMING HOPE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:STAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:618-593-1023
Mailing Address - Street 1:807 W HIGHWAY 50 STE 3
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1856
Mailing Address - Country:US
Mailing Address - Phone:618-836-8142
Mailing Address - Fax:
Practice Address - Street 1:807 W HIGHWAY 50 STE 3
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1856
Practice Address - Country:US
Practice Address - Phone:618-836-8142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health