Provider Demographics
NPI:1154161644
Name:BEHAVIOR BLOSSOMS
Entity type:Organization
Organization Name:BEHAVIOR BLOSSOMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:HYATT
Authorized Official - Middle Name:
Authorized Official - Last Name:GHARIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-624-7277
Mailing Address - Street 1:17421 WHITE HAWK DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-7022
Mailing Address - Country:US
Mailing Address - Phone:407-624-7277
Mailing Address - Fax:
Practice Address - Street 1:17421 WHITE HAWK DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-7022
Practice Address - Country:US
Practice Address - Phone:407-624-7277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty