Provider Demographics
NPI:1649976192
Name:ROOTRING, BEAU GALLUCCI (LPC)
Entity type:Individual
Prefix:
First Name:BEAU
Middle Name:GALLUCCI
Last Name:ROOTRING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 BROOKWOOD MDWS
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-4257
Mailing Address - Country:US
Mailing Address - Phone:513-520-3959
Mailing Address - Fax:
Practice Address - Street 1:7750 MONTGOMERY RD STE 110
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-4257
Practice Address - Country:US
Practice Address - Phone:513-520-3959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2204703101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health