| Grow Defined Therapy Llc | |
|
5305 River Rd N Ste B Keizer OR 97303-5324 | |
| (360) 320-6099 | |
| Not Available |
| Full Name | Grow Defined Therapy Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 5305 River Rd N Ste B, Keizer, Oregon |
| Authorized Official Name and Position | River Grow (OWNER/PROVIDER) |
| Authorized Official Contact | 3603206099 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grow Defined Therapy Llc 9450 Sw Gemini Dr Pmb 28613 Beaverton OR 97008-7105 Ph: () - | Grow Defined Therapy Llc 5305 River Rd N Ste B Keizer OR 97303-5324 Ph: (360) 320-6099 |
| NPI Number | 1740980085 |
|---|---|
| Provider Enumeration Date | 03/06/2023 |
| Last Update Date | 03/06/2023 |
| Certification Date | 03/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740980085 | NPI | - | NPPES |
| 500810951 | Medicaid | OR | |
| 500814140 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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