Provider Demographics
NPI:1467708750
Name:ROOTS COUNSELING, PLLC
Entity Type:Organization
Organization Name:ROOTS COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:CAPEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-641-8569
Mailing Address - Street 1:1771 BEAUMONT DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-9829
Mailing Address - Country:US
Mailing Address - Phone:801-641-8569
Mailing Address - Fax:801-799-7808
Practice Address - Street 1:2317 N HILL FIELD RD STE 103
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4782
Practice Address - Country:US
Practice Address - Phone:801-641-8569
Practice Address - Fax:801-799-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2624423501305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization