| Grow And Transform Licensed Clinical Social Worker Inc | |
|
27120 Eucalyptus Ave Unit G435 Moreno Valley CA 92555-4543 | |
| (901) 341-4769 | |
| (773) 675-8661 |
| Full Name | Grow And Transform Licensed Clinical Social Worker Inc |
|---|---|
| Speciality | Social Worker |
| Location | 27120 Eucalyptus Ave Unit G435, Moreno Valley, California |
| Authorized Official Name and Position | Teresa Teacher (OWNER) |
| Authorized Official Contact | 7736170566 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grow And Transform Licensed Clinical Social Worker Inc 27120 Eucalyptus Ave Unit G435 Moreno Valley CA 92555-4543 Ph: (901) 341-4769 | Grow And Transform Licensed Clinical Social Worker Inc 27120 Eucalyptus Ave Unit G435 Moreno Valley CA 92555-4543 Ph: (901) 341-4769 |
| NPI Number | 1699429217 |
|---|---|
| Provider Enumeration Date | 02/11/2022 |
| Last Update Date | 02/11/2022 |
| Certification Date | 02/11/2022 |
| Medicare PECOS PAC ID | 0244618023 |
|---|---|
| Medicare Enrollment ID | O20220607002039 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699429217 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Teresa E Teacher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356521579 PECOS PAC ID: 4789005075 Enrollment ID: I20200825002475 |
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