Provider Demographics
NPI:1316771413
Name:GROWTH EDGE THERAPY SERVICES LLC
Entity type:Organization
Organization Name:GROWTH EDGE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / LICENSED THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT
Authorized Official - Phone:952-412-3496
Mailing Address - Street 1:13830 COUNTY ROAD 43
Mailing Address - Street 2:
Mailing Address - City:COLOGNE
Mailing Address - State:MN
Mailing Address - Zip Code:55322-9182
Mailing Address - Country:US
Mailing Address - Phone:952-250-2663
Mailing Address - Fax:
Practice Address - Street 1:13830 COUNTY ROAD 43
Practice Address - Street 2:
Practice Address - City:COLOGNE
Practice Address - State:MN
Practice Address - Zip Code:55322-9182
Practice Address - Country:US
Practice Address - Phone:952-250-2663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1760938716OtherNPI