Healthcare Provider Details

I. General information

NPI: 1205419934
Provider Name (Legal Business Name): CRESCENT BLOOM CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 THALIA ST
NEW ORLEANS LA
70130-4134
US

IV. Provider business mailing address

1021 THALIA ST
NEW ORLEANS LA
70130-4134
US

V. Phone/Fax

Practice location:
  • Phone: 504-252-0251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: REBEKAH CIANCI
Title or Position: DIRECTOR
Credential: BCBA, LBA, LPC
Phone: 630-816-2004