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General NPI Number Information
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NPI Number | 1922719186
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Entity Type | Organization
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Legal Business Name | GROWTH ON THE PLAINS, LLC
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 3710 CENTRAL AVE STE 4
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City | KEARNEY
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State | NE
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Zip | 68847-8126
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Country | US
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Telephone | 308-233-1979
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Fax |
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Provider Business Mailing Address
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Address Line | 3710 CENTRAL AVE STE 4
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City | KEARNEY
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State | NE
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Zip | 68847-8126
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | DEIDRE HOLLISTER
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Credential | LCSW, LIMHP
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Telephone | 308-233-1979
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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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