Provider Demographics
NPI:1003525437
Name:BLOOMING BEHAVIORAL HEALTH INC
Entity Type:Organization
Organization Name:BLOOMING BEHAVIORAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS GALLEGO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:754-799-3780
Mailing Address - Street 1:3600 S STATE ROAD 7 STE 344
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-7203
Mailing Address - Country:US
Mailing Address - Phone:754-799-3780
Mailing Address - Fax:754-547-6353
Practice Address - Street 1:3600 S STATE ROAD 7 STE 344
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-7203
Practice Address - Country:US
Practice Address - Phone:754-799-3780
Practice Address - Fax:754-547-6353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty