# BLOSSOM FORTH FAMILY COUNSELING INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205650397
- **Authorized official:** BERENICE DURAN-GOMEZ M.A., LMFT 129876 (LMFT, CLINICAL DIRECTOR)
- **Authorized official phone:** (626) 622-5262

## Contact information

- **Practice address:** 710 S MYRTLE AVE \# 661, MONROVIA, CA 91016-3423
- **Practice address phone:** (626) 622-5262
- **Mailing address:** 710 S MYRTLE AVE \# 661, MONROVIA, CA 91016-3423
- **Mailing address phone:** (626) 622-5262

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 11/14/2024
- **Last updated:** 11/14/2024