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General NPI Number Information
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NPI Number | 1548086689
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Entity Type | Organization
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Legal Business Name | THE GROWTH GROUP
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 13784 83RD WAY N STE 200
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City | MAPLE GROVE
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State | MN
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Zip | 55369-7207
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Country | US
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Telephone | 724-261-7703
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Fax |
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Provider Business Mailing Address
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Address Line | 12425 WATERSIDE CT
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City | ROGERS
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State | MN
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Zip | 55374-3300
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Country | US
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Telephone | 724-261-7703
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA BAKKER
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Credential | LPCC
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Telephone | 724-261-7703
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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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