Provider Demographics
NPI:1760058663
Name:STRONG ROOTS THERAPY
Entity Type:Organization
Organization Name:STRONG ROOTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:616-822-5777
Mailing Address - Street 1:1011 E SUMMERFIELD GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9163
Mailing Address - Country:US
Mailing Address - Phone:616-822-5777
Mailing Address - Fax:
Practice Address - Street 1:1011 E SUMMERFIELD GLEN CIR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9163
Practice Address - Country:US
Practice Address - Phone:616-822-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)