Provider Demographics
NPI:1164279139
Name:GROW PROFESSIONAL COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:GROW PROFESSIONAL COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE-LYNN
Authorized Official - Middle Name:DIX
Authorized Official - Last Name:SCHMIT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:616-426-9226
Mailing Address - Street 1:3101 N. CENTRAL AVE.
Mailing Address - Street 2:STE 183 BOX #4728
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012
Mailing Address - Country:US
Mailing Address - Phone:520-200-1660
Mailing Address - Fax:616-825-5980
Practice Address - Street 1:3101 N CENTRAL AVE STE 183-4728
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2645
Practice Address - Country:US
Practice Address - Phone:520-200-1660
Practice Address - Fax:620-636-8512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2025-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty