{
"Npi": {
"NPI": "1306433214",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THINK GROW INNOVATE PSYCHOLOGICAL SERVICES PROFESSION CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 40",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "POOLER",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31322-0040",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-350-1495",
"MailingAddressFaxNumber": "858-790-8300",
"FirstLinePracticeLocationAddress": "3111 CAMINO DEL RIO N STE 400-450",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAN DIEGO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92108-5720",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-350-1495",
"PracticeLocationAddressFaxNumber": "858-790-8300",
"EnumerationDate": "12/26/2020",
"LastUpdateDate": "11/25/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JONES",
"AuthorizedOfficialFirstName": "LIZA",
"AuthorizedOfficialMiddleName": "T.",
"AuthorizedOfficialTitle": "OWNER/CLINICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PSYD; LMFT",
"AuthorizedOfficialTelephoneNumber": "619-350-1495",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}