Healthcare Provider Details

I. General information

NPI: 1578243564
Provider Name (Legal Business Name): GROUNDWORK THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 LUISA ST STE 5A
SANTA FE NM
87505-4091
US

IV. Provider business mailing address

PO BOX 24426
SANTA FE NM
87502-9426
US

V. Phone/Fax

Practice location:
  • Phone: 505-570-4509
  • Fax:
Mailing address:
  • Phone: 505-570-4509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMY S REICH
Title or Position: OWNER
Credential: LPCC
Phone: 505-690-9590