Healthcare Provider Details

I. General information

NPI: 1831786086
Provider Name (Legal Business Name): STEPHANIE MAUREEN GROGG LMHC, CEDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SE DIXIE HWY
STUART FL
34994-3054
US

IV. Provider business mailing address

1887 SE BOWIE ST
PORT SAINT LUCIE FL
34952-7153
US

V. Phone/Fax

Practice location:
  • Phone: 772-202-6742
  • Fax:
Mailing address:
  • Phone: 772-202-6742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18431
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: