MEDICARE: GROWING MIND INTERVENTION SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1588593131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROWING MIND INTERVENTION SERVICES LLC

Provider Business Mailing Address
First Line	:	50 BEAR CREEK DR
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-4549
Country	:	US
Telephone Number	:	304-602-3566
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 BEAR CREEK DR
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-4549
Country	:	US
Telephone Number	:	304-602-3566
Fax Number	:

Authorized Official
Title or Position	:	BOARD CERTIFIED BEHAVIOR ANALYST
Name	:	ALLISON KUKLAR
Credential	:	M.ED., BCBA
Telephone Number	:	304-602-3566

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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