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General NPI Number Information
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NPI Number | 1295244317
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Entity Type | Organization
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Legal Business Name | GROW WELL CLEVELAND
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Dates
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Enumeration Date | 09/20/2017
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 3000 BRIDGE AVE STE 4
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City | CLEVELAND
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State | OH
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Zip | 44113-3086
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Country | US
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Telephone | 216-282-3838
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 BRIDGE AVE STE 4
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City | CLEVELAND
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State | OH
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Zip | 44113-3086
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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 | DIRECTOR
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Name | JESSICA D SEN
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Credential |
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Telephone | 216-282-3838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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