1588533780 NPI number — GROWTH RINGS FAMILY THERAPY LLC

Table of content: (NPI 1588533780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588533780 NPI number — GROWTH RINGS FAMILY THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GROWTH RINGS FAMILY THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588533780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 S. OAK ST.
Provider Second Line Business Mailing Address:
PMB 118
Provider Business Mailing Address City Name:
SISTERS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-595-8682
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 W ADAMS AVE
Provider Second Line Business Practice Location Address:
SUITE 103C
Provider Business Practice Location Address City Name:
SISTERS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-595-8682
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2025

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS-MARTIN
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRINCIPAL FAMILY THERAPIST
Authorized Official Telephone Number:
541-595-8682

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com