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General NPI Number Information
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NPI Number | 1962958074
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Entity Type | Organization
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Legal Business Name | ROOTS TO GROUND COUNSELING
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Dates
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Enumeration Date | 08/29/2016
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 2500 N CIRCLE DR STE 400
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-1184
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Country | US
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Telephone | 719-331-6653
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Fax | 719-623-0458
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Provider Business Mailing Address
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Address Line | 1765 RIMWOOD DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-7874
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Country | US
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Telephone | 719-331-6653
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA A. LEBLANC
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Credential | MS,LMFT
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Telephone | 719-331-6653
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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 | 1198
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License Number State | CO
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