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NPI Code Detail

MEDICARE: GROUNDED WELLNESS INC

MEDICARE: GROUNDED WELLNESS INC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1912771221
Entity Type Code : Organization
Provider Name (Legal Business Name) : GROUNDED WELLNESS INC
Provider Business Mailing Address
First Line : 1712 N SANTA ROSA AVE
Second Line :
City : TUCSON
State : AZ
Zip : 85712-3529
Country : US
Telephone Number : 520-808-8780
Fax Number :
Provider Business Practice Location Address
First Line : 145 E UNIVERSITY BLVD
Second Line :
City : TUCSON
State : AZ
Zip : 85705-7738
Country : US
Telephone Number : 520-440-2465
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : AMBER GRULLER
Credential : LPC
Telephone Number : 520-440-2465
Provider Enumeration Date : 11/08/2023
Last Update Date : 11/08/2023

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Directions to “GROUNDED WELLNESS INC ” Practice Location

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