| Growing Minds Pc | |
|
124 E Main St Ste 2 Newport VT 05855-5561 | |
| (802) 327-0077 | |
| Not Available |
| Full Name | Growing Minds Pc |
|---|---|
| Speciality | Counselor |
| Location | 124 E Main St Ste 2, Newport, Vermont |
| Authorized Official Name and Position | Pavel Malm (OWNER / DIRECTOR) |
| Authorized Official Contact | 8023270077 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Growing Minds Pc Po Box 622 Newport VT 05855-0622 Ph: (802) 327-0077 | Growing Minds Pc 124 E Main St Ste 2 Newport VT 05855-5561 Ph: (802) 327-0077 |
| NPI Number | 1942738695 |
|---|---|
| Provider Enumeration Date | 05/25/2017 |
| Last Update Date | 05/18/2021 |
| Certification Date | 05/18/2021 |
| Medicare PECOS PAC ID | 9032551452 |
|---|---|
| Medicare Enrollment ID | O20240530000976 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942738695 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 068-0000594 (Vermont) | Primary |
| Provider Name | Pavel Malm |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154425296 PECOS PAC ID: 1850733270 Enrollment ID: I20240530001365 |
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