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General NPI Number Information
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NPI Number | 1497837173
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Entity Type | Organization
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Legal Business Name | GROW IT FORWARD, LLC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 10/16/2008
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Provider Practice Location Address
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Address Line | 3820 CLEVELAND AVE N SUITE 400
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City | ARDEN HILLS
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State | MN
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Zip | 55112-3285
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Country | US
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Telephone | 651-389-4402
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Fax | 651-389-4410
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Provider Business Mailing Address
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Address Line | 3820 CLEVELAND AVE N SUITE 400
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City | ARDEN HILLS
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State | MN
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Zip | 55112-3285
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Country | US
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Telephone | 651-389-4402
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Fax | 651-389-4410
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Authorized Official
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Title or Position | OWNER
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Name | MR. THOMAS EDWARD KING
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Credential | MSW,LICSW
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Telephone | 651-389-4002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5391
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License Number State | MN
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