Provider Demographics
NPI:1699662460
Name:ROOTED MIND THERAPY LLC
Entity type:Organization
Organization Name:ROOTED MIND THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:JUHAYNA
Authorized Official - Last Name:CORNISH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, CRC
Authorized Official - Phone:813-308-9788
Mailing Address - Street 1:7605 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-4031
Mailing Address - Country:US
Mailing Address - Phone:813-308-9788
Mailing Address - Fax:
Practice Address - Street 1:7605 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-4031
Practice Address - Country:US
Practice Address - Phone:813-308-9788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health