Provider Demographics
NPI:1275176653
Name:DEEPLY ROOTED THERAPY LLC
Entity Type:Organization
Organization Name:DEEPLY ROOTED THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGTS
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:316-833-7924
Mailing Address - Street 1:500 N MAIN ST STE 156
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2211
Mailing Address - Country:US
Mailing Address - Phone:316-833-7924
Mailing Address - Fax:
Practice Address - Street 1:500 N MAIN ST STE 156
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2211
Practice Address - Country:US
Practice Address - Phone:316-833-7924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty