| The Growing Tree | |
|
6692 Spring Arbor Rd Jackson MI 49201 | |
| (517) 750-3869 | |
| (517) 750-3673 |
| Full Name | The Growing Tree |
|---|---|
| Speciality | Psychologist |
| Location | 6692 Spring Arbor Rd, Jackson, Michigan |
| Authorized Official Name and Position | Brent Roderick Smith (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5177503869 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Growing Tree 6692 Spring Arbor Rd Jackson MI 49201-9322 Ph: (517) 750-3869 | The Growing Tree 6692 Spring Arbor Rd Jackson MI 49201 Ph: (517) 750-3869 |
| NPI Number | 1750579629 |
|---|---|
| Provider Enumeration Date | 10/04/2007 |
| Last Update Date | 08/13/2018 |
| Medicare PECOS PAC ID | 7911144548 |
|---|---|
| Medicare Enrollment ID | O20130518000086 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750579629 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6301008782 (Michigan) | Primary |
| Provider Name | Gregory W Fuller |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1174569107 PECOS PAC ID: 2062315948 Enrollment ID: I20040128001055 |
| Provider Name | Brent R Smith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558475012 PECOS PAC ID: 5193759165 Enrollment ID: I20050920001001 |
| Provider Name | Bethany K Patton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780124685 PECOS PAC ID: 3870865355 Enrollment ID: I20170817002689 |
| Provider Name | Aubrey Penn |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1932854379 PECOS PAC ID: 3971999681 Enrollment ID: I20220406000931 |
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