| Growth Minds Llc | |
|
1055 E Centerville Station Rd Dayton OH 45459-5500 | |
| (937) 241-6403 | |
| (937) 439-2984 |
| Full Name | Growth Minds Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1055 E Centerville Station Rd, Dayton, Ohio |
| Authorized Official Name and Position | Coleen Henderson (SOLE MEMBER) |
| Authorized Official Contact | 9374392984 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Growth Minds Llc 1055 E Centerville Station Rd Dayton OH 45459-5500 Ph: (937) 439-2984 | Growth Minds Llc 1055 E Centerville Station Rd Dayton OH 45459-5500 Ph: (937) 241-6403 |
| NPI Number | 1124715347 |
|---|---|
| Provider Enumeration Date | 04/18/2023 |
| Last Update Date | 04/26/2023 |
| Certification Date | 04/26/2023 |
| Medicare PECOS PAC ID | 1951760487 |
|---|---|
| Medicare Enrollment ID | O20230630002517 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124715347 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Coleen Henderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639566466 PECOS PAC ID: 9638455231 Enrollment ID: I20230630002623 |
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