Provider Demographics
NPI:1225716939
Name:RESILIENT ROOTS
Entity Type:Organization
Organization Name:RESILIENT ROOTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:425-359-5088
Mailing Address - Street 1:7710 S BLACKBERRY ST
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-8699
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 W 1ST AVE STE 1400
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3813
Practice Address - Country:US
Practice Address - Phone:425-359-5088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC CREST CONSULTATIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty