MEDICARE: BLOOMING FUTURE BEHAVIORAL HEALTH AND FAMILY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1649115742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOMING FUTURE BEHAVIORAL HEALTH AND FAMILY SERVICES

Provider Business Mailing Address
First Line	:	13203 N ENON CHURCH RD STE B-149
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23836-3122
Country	:	US
Telephone Number	:	703-829-6976
Fax Number	:

Provider Business Practice Location Address
First Line	:	13203 N ENON CHURCH RD STE B-149
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23836-3122
Country	:	US
Telephone Number	:	703-829-6976
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	LAUREN HAMILTON BUELL
Credential	:
Telephone Number	:	703-829-6976

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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