Provider Demographics
NPI:1295380236
Name:GROWTH COUNSELING AND CONSULTING
Entity Type:Organization
Organization Name:GROWTH COUNSELING AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STORMY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MBR
Authorized Official - Phone:918-407-2662
Mailing Address - Street 1:301 E MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-4416
Mailing Address - Country:US
Mailing Address - Phone:918-407-2662
Mailing Address - Fax:918-917-5261
Practice Address - Street 1:301 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-4416
Practice Address - Country:US
Practice Address - Phone:918-407-2662
Practice Address - Fax:918-917-5261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty