Active NPI
Phoenix Bloom Therapeutics, LLC
- Marriage & Family Therapist
- Covington, KY
National Provider Identifier
1700797370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Legal business name
- PHOENIX BLOOM THERAPEUTICS, LLC
- Practice address
- 31 Hideaway Dr
Covington, KY 41017-9775 - Phone
- (859) 307-4540
- NPI assigned
- Sep 14, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Tina Nichole Hacker, IMFT, LMFT, LICDC,
- Title
- Owner
- Phone
- (859) 307-4540
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | Primary |
Addresses
Primary practice location
31 Hideaway Dr
Covington, KY 41017-9775
Mailing address
31 Hideaway Dr
Covington, KY 41017-9775
Phone (859) 307-4540
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1789344000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1789344000000",
"number": "1700797370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 HIDEAWAY DR",
"city": "COVINGTON",
"state": "KY",
"postal_code": "410179775",
"telephone_number": "859-307-4540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31 HIDEAWAY DR",
"city": "COVINGTON",
"state": "KY",
"postal_code": "410179775",
"telephone_number": "859-307-4540"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PHOENIX BLOOM THERAPEUTICS, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2026-09-14",
"last_updated": "2026-09-14",
"certification_date": "2026-09-14",
"status": "A",
"authorized_official_last_name": "HACKER",
"authorized_official_first_name": "TINA",
"authorized_official_middle_name": "NICHOLE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "859-307-4540",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "IMFT, LMFT, LICDC,"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Covington, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.