Provider Demographics
NPI: | 1144466707 |
---|---|
Name: | GROWTH PROCESS INTEGRATION, INCORPORATED |
Entity type: | Organization |
Organization Name: | GROWTH PROCESS INTEGRATION, INCORPORATED |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT/CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | ANGELO |
Authorized Official - Last Name: | BORDERS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PSYD, ABPP, FAACP |
Authorized Official - Phone: | 520-826-0299 |
Mailing Address - Street 1: | 3300 N MESQUITE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | COCHISE |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85606-8729 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 520-826-0299 |
Mailing Address - Fax: | 520-826-0030 |
Practice Address - Street 1: | 3300 N MESQUITE RD |
Practice Address - Street 2: | |
Practice Address - City: | COCHISE |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85606-8729 |
Practice Address - Country: | US |
Practice Address - Phone: | 520-826-0299 |
Practice Address - Fax: | 520-826-0030 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-12-31 |
Last Update Date: | 2008-12-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 3861 | 103G00000X, 103TA0400X, 103TA0700X, 103TC2200X, 103TE1100X, 103TF0000X, 103TF0200X, 103TH0004X, 103TH0100X, 103TP0814X, 103TP2701X, 103TR0400X, 106H00000X, 146D00000X, 103TC0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | Group - Multi-Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 103TE1100X | Behavioral Health & Social Service Providers | Psychologist | Exercise & Sports | Group - Multi-Specialty |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic | Group - Multi-Specialty |
No | 103TH0004X | Behavioral Health & Social Service Providers | Psychologist | Health | Group - Multi-Specialty |
No | 103TH0100X | Behavioral Health & Social Service Providers | Psychologist | Health Service | Group - Multi-Specialty |
No | 103TP0814X | Behavioral Health & Social Service Providers | Psychologist | Psychoanalysis | Group - Multi-Specialty |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | Group - Multi-Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 146D00000X | Emergency Medical Service Providers | Personal Emergency Response Attendant | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
11233203 | Other | CAQH | |
AZ | 3861 | Other | LICENSE |
1275696924 | Other | INDIVIDUAL NPI | |
VA | 0810002999 | Other | LICENSE |