Organization
BLOOM BEHAVIORAL NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HABONE MOUSSA (OWNER)
(612) 424-2251
Entity
Organization
Contact information
Practice address
519 UNIVERSITY AVE W STE 100, SAINT PAUL, MN 55103-2162
(612) 417-3206
Mailing address
8613 PLATINUM CV, WOODBURY, MN 55129-7559
(612) 417-3206
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
06/20/2025
Last updated
07/15/2025
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