| Bloom Behavior Services LLC | |
|
910 W 14th St Ste 230 Washington MO 63090-7003 | |
| (573) 480-0440 | |
| Not Available |
| Full Name | Bloom Behavior Services LLC |
|---|---|
| Speciality | Behavior Analyst |
| Location | 910 W 14th St Ste 230, Washington, Missouri |
| Authorized Official Name and Position | Sally Marie Lavigne (OWNER/BCBA) |
| Authorized Official Contact | 5734800440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloom Behavior Services LLC 901 W 14th St Ste 230 Washington MO 63090-4198 Ph: (636) 432-6709 | Bloom Behavior Services LLC 910 W 14th St Ste 230 Washington MO 63090-7003 Ph: (573) 480-0440 |
| NPI Number | 1295329654 |
|---|---|
| Provider Enumeration Date | 02/25/2021 |
| Last Update Date | 01/22/2025 |
| Certification Date | 01/22/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295329654 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | () | Primary |
| 106S00000X | Behavior Technician | () | Secondary |
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