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General NPI Number Information
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NPI Number | 1427846724
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Entity Type | Organization
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Legal Business Name | BLOOMWELL BEHAVIORAL HEALTH INC.
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 7007 S 181ST ST STE 101A
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City | OMAHA
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State | NE
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Zip | 68136-2013
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Country | US
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Telephone | 402-819-0459
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Fax | 919-561-6112
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Provider Business Mailing Address
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Address Line | 382 NE 191ST ST STE 98090
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City | MIAMI
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State | FL
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Zip | 33179-3899
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Country | US
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Telephone | 612-201-2468
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Fax | 919-561-6112
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Authorized Official
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Title or Position | CEO
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Name | LOGAN PRATT
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Credential |
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Telephone | 612-201-2468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 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 #3
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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 #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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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 | 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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