MEDICARE: GROWTH MINDSET ABA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1568329688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROWTH MINDSET ABA, LLC

Provider Business Mailing Address
First Line	:	1944 LORRI WAY
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-1025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1944 LORRI WAY
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-1025
Country	:	US
Telephone Number	:	619-666-1205
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAINE IBARRA HARDY
Credential	:
Telephone Number	:	760-274-7448

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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