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General NPI Number Information
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NPI Number | 1851027494
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Entity Type | Organization
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Legal Business Name | GROW CONNECTED COUNSELING, PLLC
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Dates
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Enumeration Date | 07/26/2022
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 205 N MICHIGAN AVE STE 810
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City | CHICAGO
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State | IL
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Zip | 60601-5902
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Country | US
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Telephone | 708-653-0318
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Fax |
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Provider Business Mailing Address
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Address Line | 1504 TIFFANY CT
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City | LOWELL
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State | IN
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Zip | 46356-1968
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Country | US
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Telephone | 815-922-5803
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Fax |
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Authorized Official
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Title or Position | LCPC
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Name | MS. SARA MARIE MARRS O'DONNELL
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Credential |
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Telephone | 815-922-5803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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