=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962829382
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLOOM BEHAVIORAL & EDUCATIONAL SOLUTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2014
-----------------------------------------------------
Last Update Date | 12/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1842 LOCKHILL SELMA RD STE 102
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78213-1559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-643-1119
-----------------------------------------------------
Fax | 210-910-6881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1150 N LOOP 1604 W STE 108-411
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78248-4552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-643-1119
-----------------------------------------------------
Fax | 210-910-6881
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BEHAVIOR ANALYST
-----------------------------------------------------
Name | TRACI ERIN NICOLE RAMOS
-----------------------------------------------------
Credential | M.ED., BCBA
-----------------------------------------------------
Telephone | 210-643-1119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------