Organization
NOURISH2FLOURISH PSYCHOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMANDA ROTH PSY.D. (CLINICAL PSYCHOLOGIST OWNER)
(812) 929-4593
Entity
Organization
Contact information
Practice address
120 W 7TH ST, BLOOMINGTON, IN 47404
(812) 929-4593
(812) 961-6551
Mailing address
3849 S CRAMER CIR, BLOOMINGTON, IN 47403-8997
(812) 929-4593
(812) 961-6551
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1588334171
PSYCHOLOGIST
IN
Enumeration date
02/26/2022
Last updated
05/25/2023
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