Provider Demographics
NPI:1316692908
Name:GRILLEY, CONNIE JO (BCBA)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:JO
Last Name:GRILLEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N TREKELL RD LOT 35
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-1206
Mailing Address - Country:US
Mailing Address - Phone:520-333-7338
Mailing Address - Fax:
Practice Address - Street 1:2510 E HUNT HWY STE 19
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5208
Practice Address - Country:US
Practice Address - Phone:480-530-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst