Provider Demographics
NPI:1790554574
Name:COURAGE TO GROW PSYCHOLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:COURAGE TO GROW PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYD, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:350-204-3065
Mailing Address - Street 1:6333 PACIFIC AVE # 167
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-3713
Mailing Address - Country:US
Mailing Address - Phone:350-204-3065
Mailing Address - Fax:
Practice Address - Street 1:7921 KINGSWOOD DR STE A5B
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7710
Practice Address - Country:US
Practice Address - Phone:350-204-3065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty