Provider Demographics
NPI:1184643124
Name:PERSONAL GROWTH ASSOCIATES, INC.
Entity type:Organization
Organization Name:PERSONAL GROWTH ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-413-9700
Mailing Address - Street 1:919 N PLUM GROVE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5144
Mailing Address - Country:US
Mailing Address - Phone:847-413-9700
Mailing Address - Fax:847-413-1701
Practice Address - Street 1:919 N PLUM GROVE RD
Practice Address - Street 2:SUITE C
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5144
Practice Address - Country:US
Practice Address - Phone:847-413-9700
Practice Address - Fax:847-413-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210811Medicare UPIN