Blossom Behavior Consulting

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

BLOSSOM BEHAVIOR CONSULTING

Practice address

620 Clearview Dr
Charleston, SC 29412-4544

Phone

(305) 394-9379

NPI assigned

Aug 2, 2017

Organization subpart

No

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

Authorized official

Name

Mrs. Gretchen Bentz Fricker, BCBANPI 1548792955

Title

Behavior Analyst

Phone

(305) 394-9379

Specialties & licenses 2

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gretchen Bentz Fricker, BCBA

  • Behavior Analyst
  • Charleston, SC
  • NPI 1548792955
  NPD (past) Authorized official

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

{
    "created_epoch": "1501632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501632000000",
    "number": "1295259133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 CLEARVIEW DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294124544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 CLEARVIEW DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294124544",
            "telephone_number": "305-394-9379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOM BEHAVIOR CONSULTING",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-02",
        "last_updated": "2017-08-02",
        "status": "A",
        "authorized_official_last_name": "FRICKER",
        "authorized_official_first_name": "GRETCHEN",
        "authorized_official_middle_name": "BENTZ",
        "authorized_official_title_or_position": "BEHAVIOR ANALYST",
        "authorized_official_telephone_number": "305-394-9379",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE",
            "identifier": "NONE",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kerry Lynn Blome, LISW CP
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• James R Bloom, M.D.
• Blue Heron Acupuncture and Apothecary, LLC
• Blue Sky Counseling LLC
• Matthew B Blue, MD
• Amanda Blum
• Colin Blumenthal, MD MS

• All providers in Charleston, SC
• Behavior Analyst in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2017; 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.