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General NPI Number Information
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NPI Number | 1306195276
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Entity Type | Organization
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Legal Business Name | GROWING OAK LLC
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 112 WATSON ST
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City | RIPON
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State | WI
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Zip | 54971-1327
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Country | US
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Telephone | 920-896-0189
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Fax | 920-694-3021
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Provider Business Mailing Address
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Address Line | 112 WATSON ST
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City | RIPON
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State | WI
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Zip | 54971-1327
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Country | US
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Telephone | 920-896-0189
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Fax | 920-694-3021
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Authorized Official
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Title or Position | MENTAL HEALTH & SUBSTANCE ABUSE
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Name | LINDSAY LOEWE
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Credential | LPC
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Telephone | 608-469-1753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 4622-125
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License Number State | WI
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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 | 4622-125
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License Number State | WI
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