Provider Demographics
NPI:1396475802
Name:GROWING IN LEAPS AND BOUNDS COUNSELING SERVICES, PC
Entity type:Organization
Organization Name:GROWING IN LEAPS AND BOUNDS COUNSELING SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:248-520-1231
Mailing Address - Street 1:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-0274
Mailing Address - Country:US
Mailing Address - Phone:248-520-1231
Mailing Address - Fax:844-270-7373
Practice Address - Street 1:100 W BIG BEAVER RD STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5283
Practice Address - Country:US
Practice Address - Phone:248-520-1231
Practice Address - Fax:844-270-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI13644233OtherCAQH
MIVS0035702Medicaid