| Phoenix Bloom Therapeutics, LLC | |
|
31 Hideaway Dr Covington KY 41017-9775 | |
| (859) 307-4540 | |
| Not Available |
| Full Name | Phoenix Bloom Therapeutics, LLC |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 31 Hideaway Dr, Covington, Kentucky |
| Authorized Official Name and Position | Tina Nichole Hacker (OWNER) |
| Authorized Official Contact | 8593074540 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Bloom Therapeutics, LLC 31 Hideaway Dr Covington KY 41017-9775 Ph: (859) 307-4540 | Phoenix Bloom Therapeutics, LLC 31 Hideaway Dr Covington KY 41017-9775 Ph: (859) 307-4540 |
| NPI Number | 1700797370 |
|---|---|
| Provider Enumeration Date | 09/14/2026 |
| Last Update Date | 09/14/2026 |
| Certification Date | 09/14/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700797370 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | () | Primary |
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