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General NPI Number Information
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NPI Number | 1073478137
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Entity Type | Organization
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Legal Business Name | GROUNDED MIND PSYCHOLOGY PLLC
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 11994 RIDGE PKWY
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City | BROOMFIELD
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State | CO
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Zip | 80021-5155
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Country | US
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Telephone | 702-464-7515
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Fax |
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Provider Business Mailing Address
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Address Line | 4845 PEARL EAST CIRCLE STE 118 PMB 57630
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City | BOULDER
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State | CO
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Zip | 80301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMAL WAIRE
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Credential | PSYD
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Telephone | 718-915-1426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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