Provider Demographics
NPI:1871243808
Name:COGNITIVE GROWTH MENTAL HEALTH
Entity Type:Organization
Organization Name:COGNITIVE GROWTH MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CECIL
Authorized Official - Last Name:GROETKEN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:206-701-1962
Mailing Address - Street 1:3800 BRIDGEPORT WAY W STE A
Mailing Address - Street 2:#302
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4495
Mailing Address - Country:US
Mailing Address - Phone:206-701-1962
Mailing Address - Fax:
Practice Address - Street 1:6314 19TH ST W STE 7
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6223
Practice Address - Country:US
Practice Address - Phone:206-701-1962
Practice Address - Fax:866-434-6268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health