Provider Demographics
NPI:1417470436
Name:BLOOM BEHAVIORAL CONSULTING, INC.
Entity Type:Organization
Organization Name:BLOOM BEHAVIORAL CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:954-856-6926
Mailing Address - Street 1:10850 W SAMPLE RD APT 6507
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2681
Mailing Address - Country:US
Mailing Address - Phone:954-856-6926
Mailing Address - Fax:
Practice Address - Street 1:10850 W SAMPLE RD APT 6507
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-2681
Practice Address - Country:US
Practice Address - Phone:954-856-6926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-13-14404103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty