Provider Demographics
NPI:1023059839
Name:BLOOMING HEARTS,LLC
Entity type:Organization
Organization Name:BLOOMING HEARTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:MIMNA
Authorized Official - Last Name:KNAPIK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LISAC, MA
Authorized Official - Phone:520-481-9629
Mailing Address - Street 1:6160 N PASEO ZALDIVAR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1294
Mailing Address - Country:US
Mailing Address - Phone:520-797-0521
Mailing Address - Fax:
Practice Address - Street 1:6600 N ORACLE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5676
Practice Address - Country:US
Practice Address - Phone:520-481-9629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 12100101YM0800X
AZLISAC 10390101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty