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General NPI Number Information
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NPI Number | 1982567574
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Entity Type | Organization
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Legal Business Name | BLOOMMIND BEHAVIORAL GROWTH LLC
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 4301 32ND ST W STE E31
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City | BRADENTON
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State | FL
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Zip | 34205-2714
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Country | US
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Telephone | 972-880-0106
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Fax |
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Provider Business Mailing Address
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Address Line | 4301 32ND ST W STE E31
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City | BRADENTON
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State | FL
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Zip | 34205-2714
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Country | US
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Telephone | 972-880-0106
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YOLANDA YANIN GONZALEZ
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Credential |
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Telephone | 972-880-0106
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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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