Provider Demographics
NPI:1225613003
Name:ENRICHED ROOTS PLLC
Entity Type:Organization
Organization Name:ENRICHED ROOTS PLLC
Other - Org Name:ENRICHED ROOTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:MISS
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC
Authorized Official - Phone:956-962-4198
Mailing Address - Street 1:6510 POLARIS DR STE 2
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2054
Mailing Address - Country:US
Mailing Address - Phone:956-962-4198
Mailing Address - Fax:
Practice Address - Street 1:6510 POLARIS DR STE 2
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2054
Practice Address - Country:US
Practice Address - Phone:956-962-4198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-13
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty