Provider Demographics
NPI:1558013375
Name:ROOTED EMBRACE PLLC
Entity type:Organization
Organization Name:ROOTED EMBRACE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAELEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:509-714-0115
Mailing Address - Street 1:4301 S ORLANDO CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-6145
Mailing Address - Country:US
Mailing Address - Phone:509-714-0115
Mailing Address - Fax:509-694-8028
Practice Address - Street 1:4301 S ORLANDO CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-6145
Practice Address - Country:US
Practice Address - Phone:509-714-0115
Practice Address - Fax:509-694-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)