Provider Demographics
NPI:1972272714
Name:AS YOU GROW THERAPY LLC
Entity Type:Organization
Organization Name:AS YOU GROW THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:407-616-0587
Mailing Address - Street 1:2250 LUCIEN WAY STE 220
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7004
Mailing Address - Country:US
Mailing Address - Phone:407-308-2225
Mailing Address - Fax:
Practice Address - Street 1:2250 LUCIEN WAY STE 220
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7004
Practice Address - Country:US
Practice Address - Phone:407-308-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018093000Medicaid