Provider Demographics
NPI:1013577980
Name:ROOTS & REFLECTIONS, INC
Entity Type:Organization
Organization Name:ROOTS & REFLECTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAC, LAMFT
Authorized Official - Phone:479-459-7193
Mailing Address - Street 1:4943 OLD GREENWOOD RD STE 9
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-6923
Mailing Address - Country:US
Mailing Address - Phone:479-459-7193
Mailing Address - Fax:877-706-0525
Practice Address - Street 1:4943 OLD GREENWOOD RD STE 9
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6923
Practice Address - Country:US
Practice Address - Phone:479-459-7193
Practice Address - Fax:877-706-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)