Provider Demographics
NPI:1003621038
Name:NEW BLOOM THERAPY, LLC
Entity type:Organization
Organization Name:NEW BLOOM THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA, MPH
Authorized Official - Phone:615-295-8494
Mailing Address - Street 1:1412 SUZANNE DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-5615
Mailing Address - Country:US
Mailing Address - Phone:615-975-0083
Mailing Address - Fax:615-895-2422
Practice Address - Street 1:1412 SUZANNE DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-5615
Practice Address - Country:US
Practice Address - Phone:615-295-8494
Practice Address - Fax:615-895-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty