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General NPI Number Information
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NPI Number | 1902499619
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Entity Type | Organization
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Legal Business Name | GROWTH MINDSET
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Dates
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Enumeration Date | 02/12/2021
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 23470 OLIVE WOOD PLAZA DR STE 110
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City | MORENO VALLEY
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State | CA
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Zip | 92553-5220
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Country | US
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Telephone | 909-561-5602
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Fax | 951-602-7978
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Provider Business Mailing Address
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Address Line | 34277 TORREY PINES CT
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City | LAKE ELSINORE
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State | CA
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Zip | 92532-2587
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Country | US
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Telephone | 909-561-5602
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Fax | 951-602-7978
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Authorized Official
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Title or Position | CEO
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Name | MR. GAMALIEL BELTRAN CAZAREZ
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Credential | LCSW
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Telephone | 909-561-5602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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