# BLOSSOM THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BLOSSOM THERAPY LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1164230157
- **Legal business name:** BLOSSOM THERAPY LLC
- **Authorized official:** HEATHER KUNCE (LMFT CLINICAL SUPERVISOR)
- **Authorized official phone:** (402) 677-1701

## Contact information

- **Practice address:** 12515 MERIDIAN E STE 204, PUYALLUP, WA 98373-3436
- **Practice address phone:** (971) 251-0312
- **Mailing address:** 1213 32ND ST NW, PUYALLUP, WA 98371-1940
- **Mailing address phone:** (402) 677-1701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 12/21/2024
- **Last updated:** 12/21/2024