Provider Demographics
NPI:1497468060
Name:HEALING ROOTS COUNSELING
Entity Type:Organization
Organization Name:HEALING ROOTS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:612-505-0815
Mailing Address - Street 1:3200 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-2863
Mailing Address - Country:US
Mailing Address - Phone:612-505-0815
Mailing Address - Fax:
Practice Address - Street 1:3200 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-2863
Practice Address - Country:US
Practice Address - Phone:612-505-0815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty