Organization
GROW AND GLOW BEHAVIORAL HEALTH LLC
Active
Organization
GROW AND GLOW BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BLAIR-TIFFANY MCCORMICK LCSW (CEO)
(813) 701-8161
Entity
Organization
Contact information
Practice address
710 OAKFIELD DR STE 221, BRANDON, FL 33511-4924
(813) 701-8161
(813) 336-8763
Mailing address
11001 GOLDEN SILENCE DR, RIVERVIEW, FL 33579-2341
(305) 494-2843
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121009900
—
FL
Enumeration date
09/25/2023
Last updated
04/23/2026
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