Provider Demographics
NPI:1295189611
Name:BEHAVIORAL GROWING TREE
Entity Type:Organization
Organization Name:BEHAVIORAL GROWING TREE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TAVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKESELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-409-7373
Mailing Address - Street 1:7200 E DRY CREEK RD
Mailing Address - Street 2:E104
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7200 E DRY CREEK RD
Practice Address - Street 2:E104
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2537
Practice Address - Country:US
Practice Address - Phone:720-409-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health