FULL BLOOM THERAPY & CONSULTING (NPI# 1770049769) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770049769 |
| Entity Type | Organization |
| Organization Name | FULL BLOOM THERAPY & CONSULTING |
| Practice Address |
153 Park Row Ste 204 Brunswick ME 04011-2053 |
| Practice Telephone | 2078376599 |
| Mailing Telephone | 2078376599 |
| Enumeration Date | 2019-02-14 |
| Last Update Date | 2019-02-14 |
| Authorized Official Name | STACEY MICHELLE JENKINS (OWNER) |
| Authorized Official Telephone | 2078376599 |
| Authorized Official Credential | LCPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ME | 1780018119 | 05 |
| Street Address |
153 PARK ROW STE 204 |
| City | BRUNSWICK |
| State | ME |
| Zip Code | 04011-2053 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093276370 | Convenientmd LLC | Clinic/Center | 193 Bath Road, Brunswick, ME 04011 | 2019-03-28 |
| 1326571241 | Psychology Specialists of Maine | Psychologist | 14 Maine St., Suite 309, Brunswick, ME 04011 | 2017-04-07 |
| 1992249775 | Avita Brunswick LLC | Alzheimer Center (Dementia Center) | 89 Admiral Fitch Way, Brunswick, ME 04011 | 2016-12-13 |
| 1215303433 | Mary K Kunhardt | Social Worker | 116 Maquoit Rd, Brunswick, ME 04011 | 2015-08-12 |
| 1861803843 | Gretchen Jane Stevens | Counselor | 136 Maine Street, Suite #6, Brunswick, ME 04011 | 2014-05-13 |
| 1356764567 | Kid Function, Inc. | Clinic/Center | 225 Thomas Point Road, Brunswick, ME 04011 | 2014-01-23 |
| 1356788921 | Jacques M. Reynolds | Psychiatry & Neurology | 81 Medical Center Dr # 2400, Brunswick, ME 04011 | 2013-05-23 |
| 1922369891 | Charles Russell Thorp | Pharmacist | 147 Bath Rd, Rtes 1 and 24, Merry Meeting Plaza, Brunswick, ME 04011 | 2012-06-06 |
| 1992076111 | Benjamin C. Tyau | Physician Assistant | 193 Bath Rd, Brunswick, ME 04011 | 2012-01-19 |
| 1841575339 | Bluesage Therapies Inc. | Social Worker | 214 Raymond Road, Brunswick, ME 04011 | 2011-10-15 |
| Find all providers in zip 04011 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164484093 | Day One | Clinic/Center | 525 Main St, South Portland, ME 04106-5462 | 2006-04-05 |
| 1194376079 | Noah Krell Psychotherapy, LLC | Clinic/Center | 57 Exchange St Ste 203, Portland, ME 04101-5000 | 2019-09-23 |
| 1093238461 | Outlook Ccs, LLC | Clinic/Center | 74 Beach St, Saco, ME 04072-2812 | 2017-07-18 |
| 1619366945 | Katharine Evans, Lcsw | Clinic/Center | 5 Lowell St, Suite 4, Calais, ME 04619-1712 | 2015-01-09 |
| 1932454352 | Katherine K. Ryan, Phd, LLC | Clinic/Center | 251 Woodford St, Portland, ME 04103-5617 | 2012-07-23 |
| 1255526158 | Healing Connections, Pllc | Clinic/Center | 997 Main St, Sanford, ME 04073-3512 | 2007-09-13 |
| 1619185113 | Kidspeace National Centers of New England Inc | Clinic/Center | 16 Kidspeace Way, Ellsworth, ME 04605 | 2007-05-18 |
Please comment or provide details below to improve the information on FULL BLOOM THERAPY & CONSULTING.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.