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General NPI Number Information
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NPI Number | 1093539058
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Entity Type | Organization
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Legal Business Name | GROUND SHAKING FAMILY THERAPY, PLLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 6 EGYPT LN
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City | CLINTON
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State | CT
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Zip | 06413-2513
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Country | US
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Telephone | 203-823-7093
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Fax |
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Provider Business Mailing Address
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Address Line | 6 EGYPT LN
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City | CLINTON
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State | CT
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Zip | 06413-2513
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Country | US
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Telephone | 203-823-7093
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Fax |
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Authorized Official
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Title or Position | LMFT/OWNER
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Name | MEGAN ELIZABETH HUMPHREY
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Credential | LMFT
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Telephone | 203-823-7093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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