Provider Demographics
NPI:1912771221
Name:GROUNDED WELLNESS INC
Entity Type:Organization
Organization Name:GROUNDED WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRULLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:520-440-2465
Mailing Address - Street 1:1712 N SANTA ROSA AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3529
Mailing Address - Country:US
Mailing Address - Phone:520-808-8780
Mailing Address - Fax:
Practice Address - Street 1:145 E UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7738
Practice Address - Country:US
Practice Address - Phone:520-440-2465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty