Provider Demographics
NPI:1932071255
Name:BLOOM BEHAVIOR
Entity type:Organization
Organization Name:BLOOM BEHAVIOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, BCBA
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEYAMPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-283-8445
Mailing Address - Street 1:14242 HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AL
Mailing Address - Zip Code:36756-6434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14242 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AL
Practice Address - Zip Code:36756-6434
Practice Address - Country:US
Practice Address - Phone:256-283-8445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty