Provider Demographics
NPI:1073219507
Name:ROOTED MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:ROOTED MENTAL HEALTH LLC
Other - Org Name:ELIZABETH DELGROS LCSW LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGROS-RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:412-759-3919
Mailing Address - Street 1:528 COTTAGE ST NE STE 401
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3861
Mailing Address - Country:US
Mailing Address - Phone:503-583-8537
Mailing Address - Fax:503-343-3331
Practice Address - Street 1:528 COTTAGE ST NE STE 401
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3861
Practice Address - Country:US
Practice Address - Phone:503-583-8537
Practice Address - Fax:503-343-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500817801Medicaid