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General NPI Number Information
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NPI Number | 1154161644
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Entity Type | Organization
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Legal Business Name | BEHAVIOR BLOSSOMS
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 17421 WHITE HAWK DR
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City | EDMOND
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State | OK
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Zip | 73012-7022
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Country | US
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Telephone | 407-624-7277
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Fax |
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Provider Business Mailing Address
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Address Line | 17421 WHITE HAWK DR
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City | EDMOND
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State | OK
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Zip | 73012-7022
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Country | US
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Telephone | 407-624-7277
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Fax |
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Authorized Official
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Title or Position | BOARD CERTIFIED BEHAVIOR ANALYST
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Name | HYATT GHARIB
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Credential |
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Telephone | 407-624-7277
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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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