Provider Demographics
NPI:1992226468
Name:GRU, MICHELLE ASHLEY (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ASHLEY
Last Name:GRU
Suffix:
Gender:
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 MORTIMER ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1645
Mailing Address - Country:US
Mailing Address - Phone:305-343-0150
Mailing Address - Fax:888-892-0803
Practice Address - Street 1:97 MORTIMER ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-1645
Practice Address - Country:US
Practice Address - Phone:305-343-0150
Practice Address - Fax:888-892-0803
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-21-52719103K00000X
FLRBT-18-48344106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician