Healthcare Provider Details

I. General information

NPI: 1245106731
Provider Name (Legal Business Name): GROUNDED PATH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6705 DEFOE AVE
COLORADO SPRINGS CO
80911-2746
US

IV. Provider business mailing address

1230 SUNDAY SILENCE DR
KNIGHTDALE NC
27545-7481
US

V. Phone/Fax

Practice location:
  • Phone: 719-822-0339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: EVELYN STEWART
Title or Position: OWNER
Credential:
Phone: 719-822-0339