Provider Demographics
NPI:1831910637
Name:BLOOMING PATHWAYS THERAPY LLC
Entity type:Organization
Organization Name:BLOOMING PATHWAYS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MANGANELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:262-955-7786
Mailing Address - Street 1:W292S2954 ANCESTRAL DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-9203
Mailing Address - Country:US
Mailing Address - Phone:262-955-7786
Mailing Address - Fax:
Practice Address - Street 1:245 REGENCY CT STE 200
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-6167
Practice Address - Country:US
Practice Address - Phone:262-955-7786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)