Provider Demographics
NPI:1164230157
Name:BLOSSOM THERAPY LLC
Entity type:Organization
Organization Name:BLOSSOM THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-677-1701
Mailing Address - Street 1:1213 32ND ST NW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-1940
Mailing Address - Country:US
Mailing Address - Phone:402-677-1701
Mailing Address - Fax:
Practice Address - Street 1:12515 MERIDIAN E STE 204
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3436
Practice Address - Country:US
Practice Address - Phone:971-251-0312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLOSSOM THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty