Provider Demographics
NPI:1992304554
Name:BLOSSOMING MINDS INC
Entity type:Organization
Organization Name:BLOSSOMING MINDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUNT WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LSW, LCDCIII
Authorized Official - Phone:513-642-9951
Mailing Address - Street 1:4724 VINE ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45217-1254
Mailing Address - Country:US
Mailing Address - Phone:513-642-9951
Mailing Address - Fax:
Practice Address - Street 1:4724 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45217-1254
Practice Address - Country:US
Practice Address - Phone:513-642-9951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty