# BLOSSOMING WELLBEING TELEPSYCHIATRY

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

## Provider details

- **NPI number:** 1992319560
- **Authorized official:** LA TASHA AL-JARBOUA PA-C (OWNER/CEO)
- **Authorized official phone:** (304) 237-8733

## Contact information

- **Practice address:** 9800 4TH ST N STE 200, ST PETERSBURG, FL 33702-2462
- **Practice address phone:** (833) 399-0957
- **Practice address fax:** (727) 335-1174
- **Mailing address:** 9800 4TH ST N STE 200, ST PETERSBURG, FL 33702-2462
- **Mailing address phone:** (833) 399-0957
- **Mailing address fax:** (727) 335-1174

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | NULL | Yes |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/01/2020
- **Last updated:** 11/17/2020