Provider Demographics
NPI:1376246876
Name:JOURNEY OF GROWTH THERAPY, PLLC
Entity Type:Organization
Organization Name:JOURNEY OF GROWTH THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:580-682-1351
Mailing Address - Street 1:415 W. OKLAHOMA AVE
Mailing Address - Street 2:APT 6
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-2877
Mailing Address - Country:US
Mailing Address - Phone:580-682-1351
Mailing Address - Fax:
Practice Address - Street 1:1501 LERA
Practice Address - Street 2:SUITE 1
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-2877
Practice Address - Country:US
Practice Address - Phone:580-816-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOURNEY OF GROWTH THERAPY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty