Provider Demographics
NPI:1598563140
Name:GROWTH MINDSET THERAPEUTIC SERVICES, PLLC
Entity type:Organization
Organization Name:GROWTH MINDSET THERAPEUTIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JERICHOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-922-0212
Mailing Address - Street 1:47100 SCHOENHERR RD STE C
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47100 SCHOENHERR RD STE C
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4714
Practice Address - Country:US
Practice Address - Phone:810-922-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty