Organization
BLOOM THERAPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARITY MARIE BANKSTON M.ED, BCBA, LBA (BEHAVIOR ANALYST)
(985) 634-0615
Entity
Organization
Contact information
Practice address
1515 BARRYWOOD CIR W, CLARKSVILLE, TN 37042-8554
(985) 634-0615
Mailing address
1515 BARRYWOOD CIR W, CLARKSVILLE, TN 37042-8554
(985) 634-0615
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
10/27/2022
Last updated
10/27/2022
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