Healthcare Provider Details

I. General information

NPI: 1992242218
Provider Name (Legal Business Name): THE GROWING PLACE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4326 E BEACON CT
BLOOMINGTON IN
47408-3001
US

IV. Provider business mailing address

PO BOX 448
PENDLETON IN
46064-0448
US

V. Phone/Fax

Practice location:
  • Phone: 765-606-4995
  • Fax:
Mailing address:
  • Phone: 765-606-4995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateIN

VIII. Authorized Official

Name: EMILY FISHER
Title or Position: OWNER/BEHAVIOR ANALYST
Credential: M.A. ED., BCBA
Phone: 765-606-4995