Provider Demographics
NPI:1205077187
Name:ROOTES, KATIE MARIE HEIDEN (PHD, LMFT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE HEIDEN
Last Name:ROOTES
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 LINDELL BLVD STE 1100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3412
Mailing Address - Country:US
Mailing Address - Phone:314-977-8196
Mailing Address - Fax:
Practice Address - Street 1:3700 LINDELL BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3412
Practice Address - Country:US
Practice Address - Phone:314-977-8196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011037729106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health