MEDICARE: GROWTH IS FREEDOM THERAPY 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1558214593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROWTH IS FREEDOM THERAPY LLC

Provider Business Mailing Address
First Line	:	2519 S. SHIELDS ST.
Second Line	:	STE. 1K
City	:	FORT COLLINS
State	:	CO
Zip	:	80526
Country	:	US
Telephone Number	:	970-657-7555
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 CORONADO CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525
Country	:	US
Telephone Number	:	970-657-7555
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MENTAL HEALTH PROVIDER
Name	:	AUTUMN KISER
Credential	:	LCSW
Telephone Number	:	970-657-7555

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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