Provider Demographics
NPI:1144242181
Name:GROWING TREE COUNSELING CENTER, PLLC
Entity Type:Organization
Organization Name:GROWING TREE COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT, CPC
Authorized Official - Phone:828-638-5907
Mailing Address - Street 1:715 FAIRGROVE CHURCH RD SE STE 202
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-9289
Mailing Address - Country:US
Mailing Address - Phone:828-638-5907
Mailing Address - Fax:828-322-2280
Practice Address - Street 1:715 FAIRGROVE CHURCH RD SE STE 202
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9289
Practice Address - Country:US
Practice Address - Phone:828-638-5907
Practice Address - Fax:828-322-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC851106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105243Medicaid