MEDICARE: GROUNDED ROOTS MENTAL HEALTH THERAPY

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1871231936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROUNDED ROOTS MENTAL HEALTH THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 262164
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92196-2164
Country	:	US
Telephone Number	:	619-344-1282
Fax Number	:

Provider Business Practice Location Address
First Line	:	2735 TERESITA ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-5254
Country	:	US
Telephone Number	:	619-344-1282
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER/CO-CLINICAL DIRECTOR
Name	:	ANNA RAINVILLE
Credential	:	LMFT
Telephone Number	:	619-344-1282

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	09/02/2025

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Directions to “GROUNDED ROOTS MENTAL HEALTH THERAPY ” Practice Location

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