Provider Demographics
NPI:1851027494
Name:GROW CONNECTED COUNSELING, PLLC
Entity Type:Organization
Organization Name:GROW CONNECTED COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARRS O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-922-5803
Mailing Address - Street 1:1504 TIFFANY CT
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-1968
Mailing Address - Country:US
Mailing Address - Phone:815-922-5803
Mailing Address - Fax:
Practice Address - Street 1:205 N MICHIGAN AVE STE 810
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5902
Practice Address - Country:US
Practice Address - Phone:708-653-0318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health