Provider Demographics
NPI:1588901953
Name:GRODT, MISHA DAWN (MA, LPC)
Entity type:Individual
Prefix:
First Name:MISHA
Middle Name:DAWN
Last Name:GRODT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5699 E GREENWOOD PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7529
Mailing Address - Country:US
Mailing Address - Phone:303-522-3938
Mailing Address - Fax:
Practice Address - Street 1:5699 E GREENWOOD PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7529
Practice Address - Country:US
Practice Address - Phone:303-522-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-05
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11565101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional