Provider Demographics
NPI:1689268351
Name:ROOTED COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:ROOTED COUNSELING SERVICES, LLC
Other - Org Name:ROOTED COUNSELING SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:BREANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:814-375-6805
Mailing Address - Street 1:90 BEAVER DR STE 210D
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2441
Mailing Address - Country:US
Mailing Address - Phone:814-577-6518
Mailing Address - Fax:
Practice Address - Street 1:90 BEAVER DR STE 210D
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2441
Practice Address - Country:US
Practice Address - Phone:814-577-6518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1386127405OtherNPI (TYPE 1)