Provider Demographics
NPI:1497323778
Name:HEALTHY ROOTS THERAPY, LLC.
Entity Type:Organization
Organization Name:HEALTHY ROOTS THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/LCPC
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:LAURY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-305-1360
Mailing Address - Street 1:835 PEARSON ST APT 405
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6409
Mailing Address - Country:US
Mailing Address - Phone:630-815-3021
Mailing Address - Fax:
Practice Address - Street 1:415 W GOLF RD STE 59B
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3923
Practice Address - Country:US
Practice Address - Phone:847-305-1360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty