=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801719083
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLOOM BEHAVIORAL TREATMENT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2026
-----------------------------------------------------
Last Update Date | 08/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 N BRAND BLVD STE 600
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91203-2349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-794-9995
-----------------------------------------------------
Fax | 323-784-8059
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 N BRAND BLVD STE 600
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91203-2349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | INNA ALAVERDYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-794-9995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------