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General NPI Number Information
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NPI Number | 1578243564
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Entity Type | Organization
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Legal Business Name | GROUNDWORK THERAPY LLC
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 1418 LUISA ST STE 5A
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City | SANTA FE
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State | NM
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Zip | 87505-4091
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Country | US
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Telephone | 505-570-4509
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 24426
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City | SANTA FE
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State | NM
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Zip | 87502-9426
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Country | US
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Telephone | 505-570-4509
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY S REICH
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Credential | LPCC
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Telephone | 505-690-9590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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