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General NPI Number Information
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NPI Number | 1598298846
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Entity Type | Organization
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Legal Business Name | INSPIRE GROWTH, PC
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 19800 EVENSONG AVE
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City | FARMINGTON
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State | MN
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Zip | 55024-8686
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Country | US
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Telephone | 651-262-8144
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Fax |
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Provider Business Mailing Address
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Address Line | 19800 EVENSONG AVE
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City | FARMINGTON
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State | MN
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Zip | 55024-8686
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Country | US
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Telephone | 651-262-8144
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RACHEL TIEDE
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Credential | LMFT
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Telephone | 651-262-8144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 3397
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License Number State | MN
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