Basic Information
| Provider Information | |||||||||
| NPI: | 1285267765 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GROW BEHAVIOR LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GROW BEHAVIOR SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 271 WINSLOW WAY E UNIT 10405 | ||||||||
| Address2: | |||||||||
| City: | BAINBRIDGE ISLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981109972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069196546 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4088 MATTSON PL NE | ||||||||
| Address2: | |||||||||
| City: | BAINBRIDGE ISLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981102224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069196546 | ||||||||
| FaxNumber: | 2064515681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2020 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | KROMAN | ||||||||
| AuthorizedOfficialFirstName: | EMILY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2069196546 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BCBA | ||||||||
| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.