Provider Demographics
NPI:1740767912
Name:BLOSSOM SPECTRUM SERVICES LLC
Entity type:Organization
Organization Name:BLOSSOM SPECTRUM SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:661-733-0490
Mailing Address - Street 1:25845 RAILROAD AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2548
Mailing Address - Country:US
Mailing Address - Phone:661-733-0490
Mailing Address - Fax:888-876-2134
Practice Address - Street 1:25845 RAILROAD AVE STE 5
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2548
Practice Address - Country:US
Practice Address - Phone:661-733-0490
Practice Address - Fax:888-876-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty