Organization
SECOND GROWTH COUNSELING LLC
Active
Other names
Second Growth Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY CARLYN GRACE MA, LMFT (OWNER)
(618) 339-7497
Entity
Organization
Contact information
Practice address
959 SE DIVISION ST STE 520, PORTLAND, OR 97214-4672
(503) 549-4714
(503) 506-0411
Mailing address
PO BOX 90309, PORTLAND, OR 97290-0309
(503) 549-4714
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C3909
OR
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
R4154
OR
Other
Enumeration date
05/16/2018
Last updated
08/02/2023
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