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General NPI Number Information
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NPI Number | 1699495598
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Entity Type | Organization
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Legal Business Name | GROUNDED LIFE THERAPY SOLUTIONS
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 2451 EXECUTIVE DR STE 205
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City | SAINT CHARLES
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State | MO
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Zip | 63303-5606
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Country | US
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Telephone | 636-428-8802
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Fax |
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Provider Business Mailing Address
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Address Line | 3412 PIERLAND DR
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City | POCAHONTAS
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State | IL
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Zip | 62275-1524
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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 | JAMIE FITTERER
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Credential | LPC
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Telephone | 636-542-8802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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