Provider Demographics
NPI:1598522666
Name:ROOTED THERAPY & CONSULTATION, LLC
Entity Type:Organization
Organization Name:ROOTED THERAPY & CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAWCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-659-3217
Mailing Address - Street 1:227 SE ANCHOR AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-9571
Mailing Address - Country:US
Mailing Address - Phone:541-659-3217
Mailing Address - Fax:541-507-6344
Practice Address - Street 1:227 SE ANCHOR AVE
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-9571
Practice Address - Country:US
Practice Address - Phone:541-659-3217
Practice Address - Fax:541-507-6344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty