Healthcare Provider Details

I. General information

NPI: 1598671752
Provider Name (Legal Business Name): GROWING MINDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5941 W TIFFIN ST
BASCOM OH
44809
US

IV. Provider business mailing address

1305 PELTON RD
FOSTORIA OH
44830-9760
US

V. Phone/Fax

Practice location:
  • Phone: 419-420-5012
  • Fax:
Mailing address:
  • Phone: 419-420-5012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SANSANEE LONGBRAKE
Title or Position: PARTNER
Credential: LPCC
Phone: 419-420-5012