Healthcare Provider Details

I. General information

NPI: 1326795253
Provider Name (Legal Business Name): GROUNDED ROOTS COUNSELING & YOGA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5798 BLACKSHIRE PATH STE B
INVER GROVE HEIGHTS MN
55076-1622
US

IV. Provider business mailing address

5798 BLACKSHIRE PATH STE B
INVER GROVE HEIGHTS MN
55076-1622
US

V. Phone/Fax

Practice location:
  • Phone: 651-261-0140
  • Fax:
Mailing address:
  • Phone: 651-261-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE BRIGHTMAN
Title or Position: BUSINESS OWNER; PSYCHOTHERAPIST
Credential: LPCC, LADC
Phone: 808-343-9681