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General NPI Number Information
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NPI Number | 1245536127
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Entity Type | Organization
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Legal Business Name | GROWING SEED LIFE ENRICHMENT CENTER OF TEXAS, LLC.
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 02/05/2022
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Provider Practice Location Address
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Address Line | 200 W MARSHALL ST STE E1
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City | PITTSBURG
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State | TX
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Zip | 75686-1395
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Country | US
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Telephone | 903-853-5053
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Fax | 866-414-6442
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Provider Business Mailing Address
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Address Line | PO BOX 444
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City | NAPLES
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State | TX
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Zip | 75568-0444
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Country | US
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Telephone | 682-553-0417
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Fax | 866-414-6442
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Authorized Official
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Title or Position | CEO
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Name | KEITH GLENN MCGEE
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Credential | MED.
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Telephone | 903-853-5053
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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 | 59169
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License Number State | TX
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