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General NPI Number Information
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NPI Number | 1780319038
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Entity Type | Organization
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Legal Business Name | NEW GROWTH PSYCHOLOGY INC
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 801 CRESCENT WAY STE 4
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City | ARCATA
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State | CA
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Zip | 95521-6781
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Country | US
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Telephone | 707-677-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 801 CRESCENT WAY STE 4
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City | ARCATA
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State | CA
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Zip | 95521-6781
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Country | US
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Telephone | 707-677-8200
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT/CEO
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Name | JESSICA LARA
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Credential |
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Telephone | 707-677-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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