Healthcare Provider Details

I. General information

NPI: 1538542592
Provider Name (Legal Business Name): HOPE GROWS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 VT 15 E
HYDE PARK VT
05655-9319
US

IV. Provider business mailing address

PO BOX 147
HYDE PARK VT
05655-0147
US

V. Phone/Fax

Practice location:
  • Phone: 802-851-8081
  • Fax:
Mailing address:
  • Phone: 802-851-8081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0083541
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number068.0083541
License Number StateVT

VIII. Authorized Official

Name: DEBRA HILL
Title or Position: OFFICE MANAGER
Credential:
Phone: 802-851-8081