Provider Demographics
NPI:1881372167
Name:STARKS, GROVER (RBT)
Entity type:Individual
Prefix:
First Name:GROVER
Middle Name:
Last Name:STARKS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 CONGRESSIONAL BLVD.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5400
Mailing Address - Country:US
Mailing Address - Phone:317-249-2242
Mailing Address - Fax:
Practice Address - Street 1:3777 HALEY DRIVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-2608
Practice Address - Country:US
Practice Address - Phone:812-490-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-22-235710106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician