MEDICARE: GROWTH TO HARMONY MENTAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1487478830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROWTH TO HARMONY MENTAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	2597 SE VICTORY AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-6776
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2597 SE VICTORY AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-6776
Country	:	US
Telephone Number	:	772-905-7776
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	REBECCA LOURIE
Credential	:	LMFT
Telephone Number	:	772-905-7776

Provider Enumeration Date	:	11/12/2024
Last Update Date	:	11/13/2024

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