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General NPI Number Information
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NPI Number | 1245708379
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Entity Type | Organization
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Legal Business Name | BLOSSOM PARK, LLC
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 8535 E HARTFORD DR STE 206
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-5444
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Country | US
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Telephone | 602-535-8810
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Fax |
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Provider Business Mailing Address
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Address Line | 8535 E HARTFORD DR STE 206
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-5444
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Country | US
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Telephone | 602-535-8810
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. NICOLETTE CARTER
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Credential | EDD
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Telephone | 602-769-6161
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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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