Provider Demographics
NPI:1073136248
Name:TAKING ROOT COUNSELING LLC
Entity Type:Organization
Organization Name:TAKING ROOT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:LIGHT
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-908-0805
Mailing Address - Street 1:7121 W BELL RD STE 115
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8555
Mailing Address - Country:US
Mailing Address - Phone:602-908-0805
Mailing Address - Fax:
Practice Address - Street 1:7121 W BELL RD STE 115
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8555
Practice Address - Country:US
Practice Address - Phone:602-908-0805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty