Provider Demographics
NPI:1619845880
Name:BLOSSOMING FREE MENTAL HEALTH COUNSELING PLLC
Entity type:Organization
Organization Name:BLOSSOMING FREE MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:973-557-6639
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-0035
Mailing Address - Country:US
Mailing Address - Phone:845-717-0166
Mailing Address - Fax:
Practice Address - Street 1:215 IRIS CIR
Practice Address - Street 2:
Practice Address - City:MOYOCK
Practice Address - State:NC
Practice Address - Zip Code:27958-7024
Practice Address - Country:US
Practice Address - Phone:845-717-0166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty