Organization
PERSONAL GROWTH CORPORATION
Active
Other names
Personal Growth Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JON HARRIS MSW, PHD (DIRECTOR)
(208) 529-5548
Entity
Organization
Contact information
Practice address
211 S WOODRUFF, IDAHO FALLS, ID 83401
(208) 529-5548
(208) 529-5588
Mailing address
211 S WOODRUFF, SUITE A4, IDAHO FALLS, ID 83401
(208) 529-5548
(208) 529-5588
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW420
ID
Other
Enumeration date
01/31/2007
Last updated
10/07/2010
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