| Growing Branches LLC | |
|
7345 W Sand Lake Rd Ste 303 Orlando FL 32819-5205 | |
| (407) 488-9043 | |
| Not Available |
| Full Name | Growing Branches LLC |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 7345 W Sand Lake Rd Ste 303, Orlando, Florida |
| Authorized Official Name and Position | Amy Wagner (OWNER) |
| Authorized Official Contact | 4074889043 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Growing Branches LLC 12190 Canyon Sun Trl Windermere FL 34786-6537 Ph: (407) 488-9043 | Growing Branches LLC 7345 W Sand Lake Rd Ste 303 Orlando FL 32819-5205 Ph: (407) 488-9043 |
| NPI Number | 1538913082 |
|---|---|
| Provider Enumeration Date | 04/12/2024 |
| Last Update Date | 04/12/2024 |
| Certification Date | 04/12/2024 |
| Medicare PECOS PAC ID | 8022517382 |
|---|---|
| Medicare Enrollment ID | O20250814004641 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538913082 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | () | Secondary |
| 106H00000X | Marriage & Family Therapist | () | Primary |
| Provider Name | Gregory Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780314740 PECOS PAC ID: 4587199872 Enrollment ID: I20241122003636 |
| Provider Name | Amy S Wagner |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1568989697 PECOS PAC ID: 9931608296 Enrollment ID: I20250814004717 |
| Provider Name | Stephanie M Baldwin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356092696 PECOS PAC ID: 8022459874 Enrollment ID: I20250815000330 |
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