Organization
GROW DEFINED THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RIVER GROW MS (OWNER/PROVIDER)
(360) 320-6099
Entity
Organization
Contact information
Practice address
5305 RIVER RD N STE B, KEIZER, OR 97303-5324
(360) 320-6099
Mailing address
9450 SW GEMINI DR, PMB 28613, BEAVERTON, OR 97008-7105
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500810951
—
OR
05
—
500814140
—
OR
Enumeration date
03/06/2023
Last updated
03/06/2023
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