GROUNDED ROOTS PSYCHOLOGICAL SERVICES LLC

Community/Behavioral Health

Code: 251S00000X

Clinic/Center — Mental Health (Including Community Mental Health Center)

Code: 261QM0801X

Clinic/Center — Adult Mental Health

Code: 261QM0850X

Clinic/Center — Adolescent and Children Mental Health

Code: 261QM0855X

Counselor

Code: 101Y00000X