Healthcare Provider Details

I. General information

NPI: 1972425395
Provider Name (Legal Business Name): GROUNDED & BLOOMING THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E 65TH ST STE 205
INDIANAPOLIS IN
46220-1609
US

IV. Provider business mailing address

711 E 65TH ST STE 205
INDIANAPOLIS IN
46220-1609
US

V. Phone/Fax

Practice location:
  • Phone: 317-214-0948
  • Fax:
Mailing address:
  • Phone: 317-214-0948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANNA WEIDINGER
Title or Position: OWNER
Credential: LCSW
Phone: 317-214-0948