Provider Demographics
NPI:1033946918
Name:YELLOWWOOD ACADEMY
Entity type:Organization
Organization Name:YELLOWWOOD ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, BCBA
Authorized Official - Prefix:
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:812-887-4288
Mailing Address - Street 1:1530 W SHAMROCK CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-8948
Mailing Address - Country:US
Mailing Address - Phone:812-887-4288
Mailing Address - Fax:
Practice Address - Street 1:1530 W SHAMROCK CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-8948
Practice Address - Country:US
Practice Address - Phone:812-887-4288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty