Provider Demographics
NPI:1942910625
Name:ROOTED THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:ROOTED THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-780-0864
Mailing Address - Street 1:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-0687
Mailing Address - Country:US
Mailing Address - Phone:641-780-0864
Mailing Address - Fax:
Practice Address - Street 1:1109 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-7965
Practice Address - Country:US
Practice Address - Phone:641-780-0864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
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
1881930725OtherNPI 1