Provider Demographics
NPI:1831432855
Name:BLOOM & GROW THERAPY PLLC
Entity type:Organization
Organization Name:BLOOM & GROW THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-515-7953
Mailing Address - Street 1:401 E CLEVELAND ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2399
Mailing Address - Country:US
Mailing Address - Phone:720-515-7953
Mailing Address - Fax:720-306-5379
Practice Address - Street 1:401 E CLEVELAND ST STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2399
Practice Address - Country:US
Practice Address - Phone:720-515-7953
Practice Address - Fax:720-306-5379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6354101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty