# GROW DEFINED THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740980085
- **Authorized official:** MRS. RIVER GROW MS (OWNER/PROVIDER)
- **Authorized official phone:** (360) 320-6099

## Contact information

- **Practice address:** 5305 RIVER RD N STE B, KEIZER, OR 97303-5324
- **Practice address phone:** (360) 320-6099
- **Mailing address:** 9450 SW GEMINI DR, PMB 28613, BEAVERTON, OR 97008-7105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 03/06/2023
- **Last updated:** 03/06/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 500810951 | — | OR |
| 05 | — | 500814140 | — | OR |