Provider Demographics
NPI:1588260319
Name:WALLFLOWERS BLOOM FAMILY THERAPY INC
Entity type:Organization
Organization Name:WALLFLOWERS BLOOM FAMILY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGROVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-874-7851
Mailing Address - Street 1:13883 GARBER ST
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-5431
Mailing Address - Country:US
Mailing Address - Phone:818-414-8507
Mailing Address - Fax:
Practice Address - Street 1:25000 AVENUE STANFORD STE 240
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4598
Practice Address - Country:US
Practice Address - Phone:818-414-8507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty