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General NPI Number Information
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NPI Number | 1457176182
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Entity Type | Organization
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Legal Business Name | GROWING TREE THERAPY LLC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 8000 NORMANDALE LAKE BLVD SUITE 4
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City | BLOOMINGTON
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State | MN
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Zip | 55437
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Country | US
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Telephone | 612-703-2230
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Fax |
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Provider Business Mailing Address
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Address Line | 9301 RIVER ROCK DR N
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City | CHANHASSEN
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State | MN
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Zip | 55317-4746
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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 | OWNER
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Name | MOHAMED SHAFII AHMED
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Credential |
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Telephone | 612-703-2230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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