| Spirit In Bloom, Llc | |
|
5878 Blackshire Path Inver Grove Heights MN 55076-1621 | |
| (612) 239-6262 | |
| (651) 774-9576 |
| Full Name | Spirit In Bloom, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5878 Blackshire Path, Inver Grove Heights, Minnesota |
| Authorized Official Name and Position | Tina Mcdonough (CEO/MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 6122396262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spirit In Bloom, Llc 5878 Blackshire Path Inver Grove Heights MN 55076-1621 Ph: (612) 239-6262 | Spirit In Bloom, Llc 5878 Blackshire Path Inver Grove Heights MN 55076-1621 Ph: (612) 239-6262 |
| NPI Number | 1992152862 |
|---|---|
| Provider Enumeration Date | 05/19/2016 |
| Last Update Date | 11/27/2019 |
| Medicare PECOS PAC ID | 1052607843 |
|---|---|
| Medicare Enrollment ID | O20160902000813 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992152862 | NPI | - | NPPES |
| VN000088953001 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 14534 (Minnesota) | Primary |
| Provider Name | Tina Marie Mcdonough |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669815643 PECOS PAC ID: 7517107311 Enrollment ID: I20130627000621 |
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