MEDICARE: MISHA DAWN GRODT MA, LPC

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	101YP2500X	Professional Counselor	11565	CO

General Provider Information

NPI Number	:	1588901953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISHA DAWN GRODT MA, LPC

Provider Business Mailing Address
First Line	:	5699 E GREENWOOD PL
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-7529
Country	:	US
Telephone Number	:	303-522-3938
Fax Number	:

Provider Business Practice Location Address
First Line	:	5699 E GREENWOOD PL
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-7529
Country	:	US
Telephone Number	:	303-522-3938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2013
Last Update Date	:	04/18/2022

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