Provider Demographics
NPI:1568080323
Name:MINDROOTS COUNSELING PLLC
Entity Type:Organization
Organization Name:MINDROOTS COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACKERU
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-421-6680
Mailing Address - Street 1:4299 FLANDIN CT
Mailing Address - Street 2:
Mailing Address - City:STRASBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80136-8126
Mailing Address - Country:US
Mailing Address - Phone:908-421-6680
Mailing Address - Fax:
Practice Address - Street 1:190 S 1ST ST
Practice Address - Street 2:
Practice Address - City:BENNETT
Practice Address - State:CO
Practice Address - Zip Code:80102-7860
Practice Address - Country:US
Practice Address - Phone:303-622-4547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty