Provider Demographics
NPI:1649666314
Name:BLOOM BEHAVIORAL HEALTH INC.
Entity type:Organization
Organization Name:BLOOM BEHAVIORAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AGUIRRE-OCHOA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:909-614-9534
Mailing Address - Street 1:824 GLENHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1141
Mailing Address - Country:US
Mailing Address - Phone:909-614-9534
Mailing Address - Fax:
Practice Address - Street 1:824 GLENHAVEN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1141
Practice Address - Country:US
Practice Address - Phone:909-614-9534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty