Provider Demographics
NPI:1801312418
Name:GROUNDWORK PSYCHIATRY, LLC
Entity type:Organization
Organization Name:GROUNDWORK PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOUTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-808-9375
Mailing Address - Street 1:3109 W 50TH ST # 317
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2102
Mailing Address - Country:US
Mailing Address - Phone:612-808-9375
Mailing Address - Fax:
Practice Address - Street 1:2419 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3450
Practice Address - Country:US
Practice Address - Phone:612-871-3320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN610772084F0202X, 2084P0800X
CAA1163292084F0202X, 2084P0800X
AK73122084F0202X, 2084P0800X
MDD00703742084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Single Specialty