Bloom Behavioral Network

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

BLOOM BEHAVIORAL NETWORK

Practice address

519 University Ave W Ste 100
Saint Paul, MN 55103-2162

Phone

(612) 417-3206

NPI assigned

Jun 20, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Habone Moussa

Title

Owner

Phone

(612) 424-2251

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1750377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752537600000",
    "number": "1205723335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8613 PLATINUM CV",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551297559",
            "telephone_number": "612-417-3206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 UNIVERSITY AVE W STE 100",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551032162",
            "telephone_number": "612-417-3206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM BEHAVIORAL NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-20",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A",
        "authorized_official_last_name": "MOUSSA",
        "authorized_official_first_name": "HABONE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-424-2251"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michele Blom, R.N.
• Megan Bridget Blommer, MA, LMFT
• Benoit Blondeau, MD MBA
• Juan Jose Blondet Teixeira, M.D.
• Dionne Marie Blood, LICSW
• Deborah Bloom
• Robert Jay Bloom, DDS
• Blooming Future
• Blooming Stars Autism Center
• Bloomlake Transportation LLC

• All providers in Saint Paul, MN
• Early Intervention Provider Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.