Healthcare Provider Details

I. General information

NPI: 1336057397
Provider Name (Legal Business Name): THE GROWING PLACE COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 ENDERLY PL
FORT WORTH TX
76104-4120
US

IV. Provider business mailing address

1620 ENDERLY PL
FORT WORTH TX
76104-4120
US

V. Phone/Fax

Practice location:
  • Phone: 682-277-5574
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MOLLY O'NEIL
Title or Position: CLINICAL THERAPIST
Credential: LPC
Phone: 817-349-7291