=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700563376
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GROUNDED MENTAL HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2023
-----------------------------------------------------
Last Update Date | 07/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1931 SABAL PALM DR APT 408
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-5966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-999-7048
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1931 SABAL PALM DR APT 408
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-5966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-999-7048
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. DEBORAH VALVERDE
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 954-999-7048
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------