Provider Demographics
NPI:1023735321
Name:ROOTED RECOVERY AND WELLNESS, LLC
Entity type:Organization
Organization Name:ROOTED RECOVERY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:888-455-1642
Mailing Address - Street 1:85835 ALLBRITAIN LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-8403
Mailing Address - Country:US
Mailing Address - Phone:541-972-1891
Mailing Address - Fax:
Practice Address - Street 1:5418 N EAGLE RD STE 160
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-0100
Practice Address - Country:US
Practice Address - Phone:541-844-3577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty