Provider Demographics
NPI:1033085162
Name:GUIDED GROWTH BEHAVIOR SUPPORT, PLLC
Entity type:Organization
Organization Name:GUIDED GROWTH BEHAVIOR SUPPORT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:714-402-5971
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-0434
Mailing Address - Country:US
Mailing Address - Phone:714-402-5971
Mailing Address - Fax:
Practice Address - Street 1:4575 HARVEST LN
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-3620
Practice Address - Country:US
Practice Address - Phone:714-402-5971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty