Bloom Therapy Center, LLC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

BLOOM THERAPY CENTER, LLC

Practice address

1515 Barrywood Cir W
Clarksville, TN 37042-8554

Phone

(985) 634-0615

NPI assigned

Oct 27, 2022

Last updated

Oct 27, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Charity Marie Bankston, M.ED, BCBA, LBANPI 1578074118

Title

Behavior Analyst

Phone

(985) 634-0615

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charity Bankston, BCBA

  • Behavior Analyst
  • Clarksville, TN
  • NPI 1578074118
  NPD Authorized official

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

{
    "created_epoch": "1666828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666828800000",
    "number": "1548977796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 BARRYWOOD CIR W",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370428554",
            "telephone_number": "985-634-0615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 BARRYWOOD CIR W",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370428554",
            "telephone_number": "985-634-0615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM THERAPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-27",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A",
        "authorized_official_last_name": "BANKSTON",
        "authorized_official_first_name": "CHARITY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "BEHAVIOR ANALYST",
        "authorized_official_telephone_number": "985-634-0615",
        "authorized_official_credential": "M.ED, BCBA, LBA"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Ruth Blight, LMT
• Kelsey Leigh Blik
• Nicole Blocker
• Ranielle Lea Blohm, PSYD
• Bloom Counseling & Consultation (Bloom Counseling and Consultation)
• Shacarra Blount, M.ED
• Blue Sprig Pediatrics
• Nicholas Ukaih Blunk
• Lelia Suzanne Boadway, B.S
• Lewis Boatner

• Early Intervention Provider Agency in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Early Intervention Provider Agency in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; 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.