Provider Demographics
NPI:1598303471
Name:GREWAL, JASSIMRAN KAUR (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JASSIMRAN
Middle Name:KAUR
Last Name:GREWAL
Suffix:
Gender:
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N PACIFIC COAST HWY STE 1400
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-5602
Mailing Address - Country:US
Mailing Address - Phone:310-856-0800
Mailing Address - Fax:
Practice Address - Street 1:3 BETHESDA METRO CTR STE 700
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6300
Practice Address - Country:US
Practice Address - Phone:310-856-0800
Practice Address - Fax:855-566-2494
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4970103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst