MEDICARE: GROWING A BONSAI LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1124636030	OTHER		CMS-NPI (RYAN BARCLAY, LPC)

General Provider Information

NPI Number	:	1366038044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROWING A BONSAI LLC

Provider Business Mailing Address
First Line	:	1934 E CAMELBACK RD # 120-513
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4126
Country	:	US
Telephone Number	:	602-638-1658
Fax Number	:

Provider Business Practice Location Address
First Line	:	1934 E CAMELBACK RD STE 120-513
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4126
Country	:	US
Telephone Number	:	480-213-4463
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RYAN A BARCLAY
Credential	:	MC, LPC
Telephone Number	:	602-638-1658

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	12/04/2025

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Directions to “GROWING A BONSAI LLC ” Practice Location

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