Organization
BLOSSOMING MINDS PSYCHOLOGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTINE MARIE LIEDTKE PSYD., HSPP (OWNER)
(317) 967-4099
Entity
Organization
Contact information
Practice address
14074 TRADE CENTER DR STE 208, FISHERS, IN 46038-4574
(317) 967-4099
Mailing address
14074 TRADE CENTER DR STE 208, FISHERS, IN 46038-4574
(317) 967-4099
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
03/05/2024
Last updated
03/05/2024
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