| Bloom Therapy Llc | |
|
1214 11th Ave Nw Ardmore OK 73401-2448 | |
| (580) 490-2391 | |
| Not Available |
| Full Name | Bloom Therapy Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1214 11th Ave Nw, Ardmore, Oklahoma |
| Authorized Official Name and Position | Helene M Potter (OWNER/BCBA) |
| Authorized Official Contact | 5804902391 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloom Therapy Llc 1214 11th Ave Nw Ardmore OK 73401-2448 Ph: (580) 490-2391 | Bloom Therapy Llc 1214 11th Ave Nw Ardmore OK 73401-2448 Ph: (580) 490-2391 |
| NPI Number | 1265177513 |
|---|---|
| Provider Enumeration Date | 05/02/2022 |
| Last Update Date | 05/02/2022 |
| Certification Date | 04/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265177513 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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