Provider Demographics
NPI:1871254417
Name:BLOOMING MIND BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:BLOOMING MIND BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, PSYD
Authorized Official - Phone:760-277-5192
Mailing Address - Street 1:1461 E COOLEY DR STE 185
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3983
Mailing Address - Country:US
Mailing Address - Phone:909-850-4651
Mailing Address - Fax:909-850-4820
Practice Address - Street 1:1461 E COOLEY DR STE 185
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3983
Practice Address - Country:US
Practice Address - Phone:909-850-4651
Practice Address - Fax:909-850-4820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty