Healthcare Provider Details

I. General information

NPI: 1699576116
Provider Name (Legal Business Name): BLOSSOM ABA THERAPY MO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NE MISSOURI RD STE 200
LEES SUMMIT MO
64086-4722
US

IV. Provider business mailing address

229 ROUTE 70 STE 100
TOMS RIVER NJ
08755-1026
US

V. Phone/Fax

Practice location:
  • Phone: 857-327-5283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: CHAIM KAUFMAN
Title or Position: CEO
Credential:
Phone: 857-327-5283