MEDICARE: BOUND TO BLOOM BEHAVIORAL INSTITUTE

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	:	1740050632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOUND TO BLOOM BEHAVIORAL INSTITUTE

Provider Business Mailing Address
First Line	:	109 SOLSTICE CIR
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-5230
Country	:	US
Telephone Number	:	808-208-7474
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 SOLSTICE CIR
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-5230
Country	:	US
Telephone Number	:	808-208-7474
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. LAUREN CECILIA PERSONS
Credential	:	M.ED, BCBA, LBA
Telephone Number	:	808-208-7474

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	01/03/2024

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