Healthcare Provider Details

I. General information

NPI: 1245273507
Provider Name (Legal Business Name): THE GROWTH CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 N DALE MABRY HWY STE 200
TAMPA FL
33618-2040
US

IV. Provider business mailing address

14502 N DALE MABRY HWY STE 200
TAMPA FL
33618-2040
US

V. Phone/Fax

Practice location:
  • Phone: 813-517-9944
  • Fax:
Mailing address:
  • Phone: 813-517-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN PARKER
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential:
Phone: 813-517-9944