Provider Demographics
NPI:1083471460
Name:LG BEHAVIOR ANALYSIS LLC
Entity Type:Organization
Organization Name:LG BEHAVIOR ANALYSIS LLC
Other - Org Name:BLOSSOM MINDS ABA THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:305-927-0931
Mailing Address - Street 1:8000 N FEDERAL HWY STE 207
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1681
Mailing Address - Country:US
Mailing Address - Phone:305-927-0931
Mailing Address - Fax:
Practice Address - Street 1:8000 N FEDERAL HWY STE 207
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1681
Practice Address - Country:US
Practice Address - Phone:305-927-0931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health