Provider Demographics
NPI:1740050632
Name:BOUND TO BLOOM BEHAVIORAL INSTITUTE
Entity type:Organization
Organization Name:BOUND TO BLOOM BEHAVIORAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:CECILIA
Authorized Official - Last Name:PERSONS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA, LBA
Authorized Official - Phone:808-208-7474
Mailing Address - Street 1:109 SOLSTICE CIR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5230
Mailing Address - Country:US
Mailing Address - Phone:808-208-7474
Mailing Address - Fax:
Practice Address - Street 1:109 SOLSTICE CIR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-5230
Practice Address - Country:US
Practice Address - Phone:808-208-7474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty