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General NPI Number Information
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NPI Number | 1003609595
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Entity Type | Organization
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Legal Business Name | GROUNDED LIGHT LLC
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 421 SOUTH HOWES STREET
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City | FORT COLLINS
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State | CO
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Zip | 80521
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Country | US
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Telephone | 402-889-3527
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Fax |
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Provider Business Mailing Address
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Address Line | 2519 S SHIELDS STREET STE 1K PMB 1063
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City | FORT COLLINS
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State | CO
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Zip | 80526-1855
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Country | US
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Telephone | 402-889-3527
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTICE MANAGER
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Name | LISA PERMAR
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Credential |
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Telephone | 402-889-3527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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