Provider Demographics
NPI:1043028723
Name:GROWTH AND RENEWAL THERAPY
Entity type:Organization
Organization Name:GROWTH AND RENEWAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOZIER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-545-2486
Mailing Address - Street 1:PO BOX 1050
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-0050
Mailing Address - Country:US
Mailing Address - Phone:503-545-2486
Mailing Address - Fax:
Practice Address - Street 1:3014 NE 278TH AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-9706
Practice Address - Country:US
Practice Address - Phone:503-545-2486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty