Provider Demographics
NPI:1689285025
Name:BLOOMING SPRINGS MENTAL HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:BLOOMING SPRINGS MENTAL HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KUWANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, PMHNP-BC
Authorized Official - Phone:216-972-3341
Mailing Address - Street 1:11459 MAYFIELD RD STE 320
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2363
Mailing Address - Country:US
Mailing Address - Phone:216-972-3341
Mailing Address - Fax:216-208-1288
Practice Address - Street 1:11459 MAYFIELD RD STE 320
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2363
Practice Address - Country:US
Practice Address - Phone:216-972-3341
Practice Address - Fax:216-208-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty