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General NPI Number Information
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NPI Number | 1013524149
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Entity Type | Organization
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Legal Business Name | GROW, EMPOWER, TRANSFORM THERAPY, LLC
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 2700 N MACDILL AVE STE 116
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City | TAMPA
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State | FL
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Zip | 33607-2284
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Country | US
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Telephone | 813-563-8227
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10192
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City | TAMPA
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State | FL
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Zip | 33679-0192
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Country | US
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Telephone | 813-563-8227
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Fax |
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Authorized Official
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Title or Position | OWNER, CLINICAL DIRECTOR
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Name | MRS. DENISE D MOORE
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Credential | LMHC, QS
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Telephone | 813-563-8227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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