Healthcare Provider Details

I. General information

NPI: 1992474944
Provider Name (Legal Business Name): GROWING TOGETHER ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2021
Last Update Date: 09/12/2021
Certification Date: 09/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6789 SOUTHPOINT PKWY STE 100
JACKSONVILLE FL
32216-8205
US

IV. Provider business mailing address

6789 SOUTHPOINT PKWY STE 100
JACKSONVILLE FL
32216-8205
US

V. Phone/Fax

Practice location:
  • Phone: 904-379-6045
  • Fax: 904-301-4741
Mailing address:
  • Phone: 904-379-6045
  • Fax: 904-301-4741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA KRAMER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 904-379-6045