1508310335 NPI number — THE GROWING TREE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508310335 NPI number — THE GROWING TREE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE GROWING TREE, 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:
1508310335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5412 HIGHWAY 25
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
FLOWOOD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39232-7136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5412 HIGHWAY 25
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
FLOWOOD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39232-7136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-401-0422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BELL
Authorized Official First Name:
BRITTANY
Authorized Official Middle Name:
JOY
Authorized Official Title or Position:
BEHAVIOR ANALYST
Authorized Official Telephone Number:
601-401-0422

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  160017 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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