| Grow Wellness Healing Life | |
|
705 E Laharpe St Ste C Kirksville MO 63501-4526 | |
| (660) 988-9669 | |
| (660) 280-2965 |
| Full Name | Grow Wellness Healing Life |
|---|---|
| Speciality | Counselor |
| Location | 705 E Laharpe St Ste C, Kirksville, Missouri |
| Authorized Official Name and Position | Joni Bennett (PRESIDENT) |
| Authorized Official Contact | 6609889669 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grow Wellness Healing Life Po Box 924 Kirksville MO 63501-0924 Ph: (660) 988-9669 | Grow Wellness Healing Life 705 E Laharpe St Ste C Kirksville MO 63501-4526 Ph: (660) 988-9669 |
| NPI Number | 1750848032 |
|---|---|
| Provider Enumeration Date | 02/22/2019 |
| Last Update Date | 10/25/2024 |
| Certification Date | 10/25/2024 |
| Medicare PECOS PAC ID | 1658719968 |
|---|---|
| Medicare Enrollment ID | O20240405001330 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750848032 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| Provider Name | Joni Sue Bennett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134631286 PECOS PAC ID: 2567800873 Enrollment ID: I20240405001397 |
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