Organization
BLOOMING MIND PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY WOLTJER MS, LPC, NCC (MENTAL HEALTH THERAPIST)
(918) 280-9166
Entity
Organization
Contact information
Practice address
715 W MAIN ST STE L, JENKS, OK 74037-3553
(918) 280-9166
Mailing address
715 W MAIN ST STE L, JENKS, OK 74037-3553
(918) 280-9166
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200892560A
—
OK
Enumeration date
11/28/2022
Last updated
11/28/2022
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