Provider Demographics
NPI:1497837173
Name:GROW IT FORWARD, LLC
Entity Type:Organization
Organization Name:GROW IT FORWARD, LLC
Other - Org Name:THOMAS KING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LICSW
Authorized Official - Phone:651-389-4002
Mailing Address - Street 1:3820 CLEVELAND AVE N
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3285
Mailing Address - Country:US
Mailing Address - Phone:651-389-4402
Mailing Address - Fax:651-389-4410
Practice Address - Street 1:3820 CLEVELAND AVE N
Practice Address - Street 2:SUITE 400
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-3285
Practice Address - Country:US
Practice Address - Phone:651-389-4402
Practice Address - Fax:651-389-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP23667OtherHEALTH PARTNERS
MN1851490361OtherINDIVIDUAL NPI
MN79B37KIOtherBLUE CROSS
MN658794100Medicaid
MN6272579OtherUNITED BEHAVIORAL HEALTH