Healthcare Provider Details

I. General information

NPI: 1710827225
Provider Name (Legal Business Name): GROWING WITH GRACE AUTISM BEHAVIOR SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 RUBY ST
OZARK AL
36360-2621
US

IV. Provider business mailing address

209 RUBY ST
OZARK AL
36360-2621
US

V. Phone/Fax

Practice location:
  • Phone: 334-764-4113
  • Fax: 334-764-4113
Mailing address:
  • Phone: 334-764-4113
  • Fax: 334-764-4113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY GRACE GRISSETT
Title or Position: OWNER
Credential: MA
Phone: 334-764-4113