Provider Demographics
NPI:1962829382
Name:BLOOM BEHAVIORAL & EDUCATIONAL SOLUTIONS, LLC
Entity type:Organization
Organization Name:BLOOM BEHAVIORAL & EDUCATIONAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:ERIN NICOLE
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:210-643-1119
Mailing Address - Street 1:14411 LARKSTONE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4728
Mailing Address - Country:US
Mailing Address - Phone:210-643-1119
Mailing Address - Fax:
Practice Address - Street 1:14411 LARKSTONE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4728
Practice Address - Country:US
Practice Address - Phone:210-643-1119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty