Nourish2Flourish Psychology, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

NOURISH2FLOURISH PSYCHOLOGY, LLC

Practice address

120 W 7TH St
Bloomington, IN 47404

Phone

(812) 929-4593

Fax

(812) 961-6551

NPI assigned

Feb 26, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Amanda Roth, PSY.D.NPI 1588334171

Title

Clinical Psychologist Owner

Phone

(812) 929-4593

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amanda Marie Roth, PSYD

  • Psychologist
  • Bloomington, IN
  • NPI 1588334171
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684972800000",
    "number": "1053067124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3849 S CRAMER CIR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474038997",
            "telephone_number": "812-929-4593",
            "fax_number": "812-961-6551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 W 7TH ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47404",
            "telephone_number": "812-929-4593",
            "fax_number": "812-961-6551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOURISH2FLOURISH PSYCHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-26",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A",
        "authorized_official_last_name": "ROTH",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST OWNER",
        "authorized_official_telephone_number": "812-929-4593",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGIST",
            "identifier": "1588334171",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.