Provider Demographics
NPI:1962078477
Name:GROW TRUE PSYCHOLOGY PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GROW TRUE PSYCHOLOGY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:OTHENE
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-601-6055
Mailing Address - Street 1:11990 SAN VICENTE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6608
Mailing Address - Country:US
Mailing Address - Phone:805-601-6055
Mailing Address - Fax:
Practice Address - Street 1:11990 SAN VICENTE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6608
Practice Address - Country:US
Practice Address - Phone:805-601-6055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty