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General NPI Number Information
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NPI Number | 1215334503
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Entity Type | Organization
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Legal Business Name | GROWING SELF, LLC
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 100 FILLMORE ST
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City | DENVER
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State | CO
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Zip | 80206-4916
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Country | US
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Telephone | 720-208-6806
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Fax |
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Provider Business Mailing Address
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Address Line | 100 FILLMORE ST
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City | DENVER
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State | CO
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Zip | 80206-4916
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | LISA BOBBY
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Credential | PHD, LMFT
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Telephone | 720-208-6806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0011953
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License Number State | CO
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