In Full Bloom Counseling, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

IN FULL BLOOM COUNSELING, LLC

Practice address

6417 Penn Ave S Ste 7-1334
Minneapolis, MN 55423-1186

Phone

(612) 208-2265

NPI assigned

Sep 10, 2024

Last updated

Sep 10, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Evonne Broten, MANPI 1376125179

Title

Owner

Phone

(612) 208-2265

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Evonne Broten

  • Mental Health Counselor
  • Minneapolis, MN
  • NPI 1376125179
  NPD Authorized official

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

{
    "created_epoch": "1725926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1255167847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6417 PENN AVE S STE 7-1334",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554231186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6417 PENN AVE S STE 7-1334",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554231186",
            "telephone_number": "612-208-2265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IN FULL BLOOM COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-10",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "BROTEN",
        "authorized_official_first_name": "EVONNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-208-2265",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; 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.