# BLOOMING CLEMATIS THERAPY & CONSULTING LLC

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

## Provider details

- **NPI number:** 1558055152
- **Authorized official:** VICKI DAVIS CREDENTIALING (CREDENTIALING MANAGER)
- **Authorized official phone:** (602) 609-5255

## Contact information

- **Practice address:** 2214 W LOS ARBOLES PL, CHANDLER, AZ 85224-2143
- **Practice address phone:** (480) 340-1236
- **Mailing address:** PO BOX 8130, CHANDLER, AZ 85246-8130
- **Mailing address phone:** (480) 340-1236

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 06/06/2023
- **Last updated:** 06/06/2023