MEDICARE: BLOOM BEHAVIORAL CO. LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1548114838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM BEHAVIORAL CO. LLC

Provider Business Mailing Address
First Line	:	6000 JAYCOX RD APT 101
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-1672
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 JAYCOX RD APT 101
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-1672
Country	:	US
Telephone Number	:	440-506-6084
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ BCBA
Name	:	MARQUEZIA WILLIAMS
Credential	:	BCBA
Telephone Number	:	440-506-6084

Provider Enumeration Date	:	02/24/2026
Last Update Date	:	02/24/2026

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