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General NPI Number Information
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NPI Number | 1538913082
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Entity Type | Organization
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Legal Business Name | GROWING BRANCHES LLC
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Dates
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Enumeration Date | 04/12/2024
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Last Update Date | 04/12/2024
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Provider Practice Location Address
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Address Line | 7345 W SAND LAKE RD STE 303
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City | ORLANDO
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State | FL
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Zip | 32819-5205
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Country | US
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Telephone | 407-488-9043
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Fax |
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Provider Business Mailing Address
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Address Line | 12190 CANYON SUN TRL
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City | WINDERMERE
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State | FL
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Zip | 34786-6537
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Country | US
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Telephone | 407-488-9043
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY WAGNER
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Credential | LMHC LMFT
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Telephone | 407-488-9043
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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