Healthcare Provider Details

I. General information

NPI: 1629987722
Provider Name (Legal Business Name): GROW & BLOOM ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7067 DAY ST
TUJUNGA CA
91042-2441
US

IV. Provider business mailing address

7067 DAY ST
TUJUNGA CA
91042-2441
US

V. Phone/Fax

Practice location:
  • Phone: 818-421-0885
  • Fax:
Mailing address:
  • Phone: 818-421-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARIAM MELIDONIAN
Title or Position: MANAGER
Credential:
Phone: 818-421-0885