Provider Demographics
NPI:1760201636
Name:NEW GROWTH MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:NEW GROWTH MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDER BROEK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:605-215-0609
Mailing Address - Street 1:311 S PHILLIPS AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-6420
Mailing Address - Country:US
Mailing Address - Phone:605-215-0609
Mailing Address - Fax:
Practice Address - Street 1:311 S PHILLIPS AVE STE 203
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-6420
Practice Address - Country:US
Practice Address - Phone:605-215-0609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty