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General NPI Number Information
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NPI Number | 1043120058
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Entity Type | Organization
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Legal Business Name | YOUR GROUNDED PATH THERAPY LLC
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 1310 SW 2ND CT APT 209
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-7706
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Country | US
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Telephone | 954-240-6450
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 SW 2ND CT APT 209
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-7706
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Country | US
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Telephone | 954-240-6450
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MS. SAMANTHA F HACKER
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Credential | LMHC, PHARMD
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Telephone | 954-240-6450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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