Mallory Therese Grimm, M.ED, BCBA, COBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

COBA.01005. Issued in OH

Practice address

6005 Landerhaven Dr Ste B1
Mayfield Heights, OH 44124-4042

Phone

(216) 343-1198

NPI assigned

Apr 6, 2022

Last updated

Apr 6, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Target ABA

  dba On Target ABA

  • Behavior Analyst
  • Mayfield Heights, OH
  • NPI 1902583081
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1962143503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6005 LANDERHAVEN DR STE B1",
            "city": "MAYFIELD HEIGHTS",
            "state": "OH",
            "postal_code": "441244042",
            "telephone_number": "216-343-1198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6005 LANDERHAVEN DR STE B1",
            "city": "MAYFIELD HEIGHTS",
            "state": "OH",
            "postal_code": "441244042",
            "telephone_number": "216-343-1198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMM",
        "first_name": "MALLORY",
        "middle_name": "THERESE",
        "credential": "M.ED, BCBA, COBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-06",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "OH",
            "license": "COBA.01005.",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "DatafinchCatalyst",
            "affiliation": "N",
            "endpointDescription": "Data collection, SOAP note collection",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6005 Landerhaven Dr Ste B1",
            "city": "Mayfield Heights",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441244042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Britni A Gray
• Jessica R Gray, FNP-BC
• Steven Greene, RPH
• Kathryn Greenwald
• Marco Gregory
• GTF Solutions LLC
• Celita Gulley
• Dragana Gundic, CNP
• Alexandra Elizabeth Gunner
• Rebecca Lindsey Gunter, M.D.

• Behavior Analyst in Mayfield Heights, OH
• Providers in Mayfield Heights, OH by specialty
• Behavior Analyst in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.