Healthcare Provider Details

I. General information

NPI: 1114317864
Provider Name (Legal Business Name): GROWTH COUNSELING GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 FILLMORE ST 114
DENVER CO
80206-1514
US

IV. Provider business mailing address

10027 DEER CREEK ST
HIGHLANDS RANCH CO
80129-4357
US

V. Phone/Fax

Practice location:
  • Phone: 303-578-8083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0011402
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09923340
License Number StateCO

VIII. Authorized Official

Name: JOSHUA KAPLAN
Title or Position: OWNER THERAPIST
Credential: LCSW
Phone: 303-578-8083