=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477482834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVERBLOOM THERAPY & CO.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2026
-----------------------------------------------------
Last Update Date | 05/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6115 SW 18TH ST
-----------------------------------------------------
City | GUTHRIE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73044-7603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-273-5852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6115 SW 18TH ST
-----------------------------------------------------
City | GUTHRIE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73044-7603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-273-5852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SARAH JEAN SAXON STAFFORD
-----------------------------------------------------
Credential | M.A., BCBA-LBA
-----------------------------------------------------
Telephone | 580-273-5852
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------