Organization
BLOOM BEHAVIOR THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BECKY L NASTALLY PHD, BCBA-D, LBA (OWNER)
(270) 908-0461
Entity
Organization
Contact information
Practice address
6201 BENTON RD, PADUCAH, KY 42003-1304
(270) 908-0461
(270) 366-0780
Mailing address
6201 BENTON RD, PADUCAH, KY 42003-1304
(270) 908-0461
(270) 366-0780
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
KY-0016
KY
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
800217
KY
Other
Enumeration date
01/05/2012
Last updated
07/08/2021
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