Provider Demographics
NPI:1013339076
Name:POTENTIAL GROWTH LLC
Entity Type:Organization
Organization Name:POTENTIAL GROWTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JARUTOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:210-289-7686
Mailing Address - Street 1:1438 COUNTY ROAD 314
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-3340
Mailing Address - Country:US
Mailing Address - Phone:210-289-7686
Mailing Address - Fax:866-654-7301
Practice Address - Street 1:1438 COUNTY ROAD 314
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3340
Practice Address - Country:US
Practice Address - Phone:210-289-7686
Practice Address - Fax:866-654-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-13-12822103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty