Healthcare Provider Details

I. General information

NPI: 1447842810
Provider Name (Legal Business Name): GROUNDED GROWTH COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 E OMAHA ST STE D
RAPID CITY SD
57701-2974
US

IV. Provider business mailing address

756 EARLEEN ST APT C
RAPID CITY SD
57701-3219
US

V. Phone/Fax

Practice location:
  • Phone: 605-786-6759
  • Fax:
Mailing address:
  • Phone: 605-786-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ANITA RUTH HARTL
Title or Position: CLINICAL SOCIAL WORKER
Credential: CSW-PIP
Phone: 605-786-6759