Healthcare Provider Details

I. General information

NPI: 1568102341
Provider Name (Legal Business Name): G.R.O.W.T.H. COUNSELING AND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N MIAMI BEACH BLVD
NORTH MIAMI BEACH FL
33162-3842
US

IV. Provider business mailing address

1001 N MIAMI BEACH BLVD
NORTH MIAMI BEACH FL
33162-3842
US

V. Phone/Fax

Practice location:
  • Phone: 786-320-5559
  • Fax: 786-796-1021
Mailing address:
  • Phone:
  • Fax:

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: KIMBERLY LYNN ROBERTS
Title or Position: OWNER
Credential:
Phone: 786-320-5559