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General NPI Number Information
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NPI Number | 1144041708
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Entity Type | Organization
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Legal Business Name | NOVABLOOM CENTERS LLC
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 807 CAMERON CT
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City | COPPELL
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State | TX
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Zip | 75019-4751
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Country | US
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Telephone | 214-235-9716
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Fax |
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Provider Business Mailing Address
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Address Line | 807 CAMERON CT
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City | COPPELL
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State | TX
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Zip | 75019-4751
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Country | US
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Telephone | 214-235-9716
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | RISHI PATEL
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Credential |
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Telephone | 214-235-9716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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