Provider Demographics
NPI:1982445300
Name:GROWTH PSYCHOLOGY
Entity type:Organization
Organization Name:GROWTH PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:716-395-9605
Mailing Address - Street 1:702 CLEVELAND ST APT 2304
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-5254
Mailing Address - Country:US
Mailing Address - Phone:716-395-9605
Mailing Address - Fax:
Practice Address - Street 1:702 CLEVELAND ST APT 2304
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-5254
Practice Address - Country:US
Practice Address - Phone:716-395-9605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX39108OtherPSYCHOLOGIST LICENSE