Provider Demographics
NPI:1194392159
Name:ROOT COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:ROOT COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMFT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROOT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:218-721-2370
Mailing Address - Street 1:902 E 2ND ST STE 224
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6509
Mailing Address - Country:US
Mailing Address - Phone:218-721-2370
Mailing Address - Fax:
Practice Address - Street 1:902 E 2ND ST STE 224
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6509
Practice Address - Country:US
Practice Address - Phone:218-721-2370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health