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General NPI Number Information
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NPI Number | 1740767912
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Entity Type | Organization
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Legal Business Name | BLOSSOM SPECTRUM SERVICES LLC
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 25845 RAILROAD AVE STE 5
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City | SANTA CLARITA
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State | CA
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Zip | 91350-2548
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Country | US
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Telephone | 661-733-0490
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Fax | 888-876-2134
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Provider Business Mailing Address
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Address Line | 25845 RAILROAD AVE STE 5
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City | SANTA CLARITA
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State | CA
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Zip | 91350-2548
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Country | US
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Telephone | 661-733-0490
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Fax | 888-876-2134
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Authorized Official
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Title or Position | BEHAVIOR ANALYST
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Name | APRIL WYATT
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Credential | BCBA
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Telephone | 661-733-0490
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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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