MEDICARE: GROUNDWORK PSYCHOLOGICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist
2	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1376422006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROUNDWORK PSYCHOLOGICAL SERVICES

Provider Business Mailing Address
First Line	:	4965 ABBOT RUN CT
Second Line	:
City	:	LIBERTY TWP
State	:	OH
Zip	:	45011-8656
Country	:	US
Telephone Number	:	513-254-8894
Fax Number	:

Provider Business Practice Location Address
First Line	:	4965 ABBOT RUN CT
Second Line	:
City	:	LIBERTY TWP
State	:	OH
Zip	:	45011-8656
Country	:	US
Telephone Number	:	513-254-8894
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AARON DAVID MILLER
Credential	:	PH.D.
Telephone Number	:	513-254-8894

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	08/27/2025

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Directions to “GROUNDWORK PSYCHOLOGICAL SERVICES ” Practice Location

Language	Start Address	Practice Location

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