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General NPI Number Information
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NPI Number | 1598621302
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Entity Type | Organization
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Legal Business Name | BLOOMING MINDS BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 12/25/2025
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Last Update Date | 12/25/2025
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Provider Practice Location Address
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Address Line | 11252 S SACRAMENTO AVE
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City | CHICAGO
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State | IL
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Zip | 60655-2302
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Country | US
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Telephone | 239-944-1670
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Fax |
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Provider Business Mailing Address
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Address Line | 11252 S SACRAMENTO AVE
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City | CHICAGO
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State | IL
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Zip | 60655-2302
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Country | US
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Telephone | 239-944-1670
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Fax |
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Authorized Official
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Title or Position | BCBA
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Name | KATYA LOPEZ
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Credential | M.A., BCBA, LBA
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Telephone | 239-944-1670
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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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