# SPIRITUAL GROWTH THERAPY TRAUMA AND WELLNESS CENTER, LLC

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

## Provider details

- **NPI number:** 1912453432
- **Authorized official:** DR. LISA ALLEVA PH.D., LMFT (CEO)
- **Authorized official phone:** (561) 350-9567

## Contact information

- **Practice address:** 6773 BONIELLO DR, BOCA RATON, FL 33496-1546
- **Practice address phone:** (561) 350-9567
- **Mailing address:** 6773 BONIELLO DR, BOCA RATON, FL 33496-1546

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 08/26/2016
- **Last updated:** 08/26/2016