| Infinite Bloom Therapy Llc | |
|
2611 Sw 17th St Topeka KS 66604-2603 | |
| (785) 250-5002 | |
| Not Available |
| Full Name | Infinite Bloom Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2611 Sw 17th St, Topeka, Kansas |
| Authorized Official Name and Position | Krystal Kershaw (SOLE PROPRIETOR) |
| Authorized Official Contact | 7852505002 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Infinite Bloom Therapy Llc 1115 Sw Lincoln St Topeka KS 66604-1239 Ph: (785) 250-5002 | Infinite Bloom Therapy Llc 2611 Sw 17th St Topeka KS 66604-2603 Ph: (785) 250-5002 |
| NPI Number | 1932958535 |
|---|---|
| Provider Enumeration Date | 05/15/2024 |
| Last Update Date | 06/24/2024 |
| Certification Date | 06/24/2024 |
| Medicare PECOS PAC ID | 5890231500 |
|---|---|
| Medicare Enrollment ID | O20240718000692 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932958535 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Krystal Kershaw |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083143168 PECOS PAC ID: 7618364407 Enrollment ID: I20220426000949 |
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