Healthcare Provider Details

I. General information

NPI: 1710881370
Provider Name (Legal Business Name): THE GROUNDED PATH PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR STE 110-3007
CHICAGO IL
60611-4546
US

IV. Provider business mailing address

680 N LAKE SHORE DR STE 110-3007
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 865-599-4748
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ELLIOTT NOLAN DEVORE
Title or Position: FOUNDER/CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 865-599-4748