Provider Demographics
NPI:1528542149
Name:CENTER FOR POST TRAUMATIC GROWTH
Entity Type:Organization
Organization Name:CENTER FOR POST TRAUMATIC GROWTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:LIC PSYCHOLOGIST
Authorized Official - Phone:720-743-7673
Mailing Address - Street 1:5521 GRASSY RUN CT
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-9739
Mailing Address - Country:US
Mailing Address - Phone:916-743-7673
Mailing Address - Fax:
Practice Address - Street 1:11344 COLOMA RD STE 347
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4460
Practice Address - Country:US
Practice Address - Phone:916-743-7673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty