Provider Demographics
NPI:1386357663
Name:BE GROUNDED YOGA LLC
Entity type:Organization
Organization Name:BE GROUNDED YOGA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:608-445-6697
Mailing Address - Street 1:5796 COUNTY ROAD A
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-2669
Mailing Address - Country:US
Mailing Address - Phone:608-445-6697
Mailing Address - Fax:
Practice Address - Street 1:6601 GRAND TETON PLZ STE B3
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1056
Practice Address - Country:US
Practice Address - Phone:608-535-6383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43701500Medicaid