Provider Demographics
NPI:1144531757
Name:THE GROWING TREE COUNSELING & WELLNESS
Entity type:Organization
Organization Name:THE GROWING TREE COUNSELING & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:EGGUM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:920-582-4000
Mailing Address - Street 1:140 W MAIN ST
Mailing Address - Street 2:PO BOX 486
Mailing Address - City:WINNECONNE
Mailing Address - State:WI
Mailing Address - Zip Code:54986-9409
Mailing Address - Country:US
Mailing Address - Phone:920-582-4000
Mailing Address - Fax:
Practice Address - Street 1:140 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:WINNECONNE
Practice Address - State:WI
Practice Address - Zip Code:54986-9409
Practice Address - Country:US
Practice Address - Phone:920-582-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty