MEDICARE: GROWTH PSYCHOLOGY

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	103T00000X	Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39108	OTHER	TX	PSYCHOLOGIST LICENSE

General Provider Information

NPI Number	:	1982445300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROWTH PSYCHOLOGY

Provider Business Mailing Address
First Line	:	702 CLEVELAND ST APT 2304
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-5254
Country	:	US
Telephone Number	:	716-395-9605
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 CLEVELAND ST APT 2304
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-5254
Country	:	US
Telephone Number	:	716-395-9605
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRIAN THOMAS KLINE
Credential	:	LP
Telephone Number	:	716-395-9605

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	02/02/2025

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Directions to “GROWTH PSYCHOLOGY ” Practice Location

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