Provider Demographics
NPI:1427532910
Name:THE PRACTICE OF BLOOMING LLC
Entity type:Organization
Organization Name:THE PRACTICE OF BLOOMING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:VIOLET
Authorized Official - Middle Name:
Authorized Official - Last Name:VORLET
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:503-468-9897
Mailing Address - Street 1:750 COMMERCIAL ST STE 210
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-4546
Mailing Address - Country:US
Mailing Address - Phone:503-468-9897
Mailing Address - Fax:
Practice Address - Street 1:750 COMMERCIAL ST STE 210
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4546
Practice Address - Country:US
Practice Address - Phone:503-468-9897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty