NPIMap

Organization Active NPI

In Bloom ABA, LLC

  • Behavior Analyst
  • Clarksville, TN
National Provider Identifier
1508455205
Registry record updated Jan 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
IN BLOOM ABA, LLC
Practice address
3142 Whitetail Dr
Clarksville, TN 37043
Phone
(931) 249-5286
NPI assigned
Jan 16, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2021

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

Authorized official

Name
Heather Conrad-Smith, BCBANPI 1598002065
Title
Owner/Manager
Phone
(931) 249-5286

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X Primary

Addresses

Primary practice location

3142 Whitetail Dr
Clarksville, TN 37043

Mailing address

3142 Whitetail Dr
Clarksville, TN 37043
Phone (931) 249-5286

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1610755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610755200000",
    "number": "1508455205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3142 WHITETAIL DR",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "37043",
            "telephone_number": "931-249-5286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3142 WHITETAIL DR",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "37043",
            "telephone_number": "931-249-5286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IN BLOOM ABA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-16",
        "last_updated": "2021-01-16",
        "certification_date": "2021-01-16",
        "status": "A",
        "authorized_official_last_name": "CONRAD-SMITH",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "931-249-5286",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2021; 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.