Organization
GROWING MINDS LEARNING CENTER, LLC
Active
Other names
Surpass Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA KIRK (REVENUE CYCLE MANAGER)
(615) 880-5782
Entity
Organization
Contact information
Practice address
1048 ASHLEY ST STE 101, BOWLING GREEN, KY 42103-2449
(615) 696-6761
(615) 880-5782
Mailing address
PO BOX 931142, ATLANTA, GA 31193-1142
(615) 696-6761
(615) 880-5782
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7100174590
SCL WAIVER
KY
05
—
7100215710
—
KY
Enumeration date
08/23/2011
Last updated
09/19/2023
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