Provider Demographics
NPI:1750741245
Name:LIFE ROOTS COUNSELING, PLLC
Entity type:Organization
Organization Name:LIFE ROOTS COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STEADMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LICSW
Authorized Official - Phone:360-863-2934
Mailing Address - Street 1:420 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2828
Mailing Address - Country:US
Mailing Address - Phone:360-863-2934
Mailing Address - Fax:
Practice Address - Street 1:1721 HEWITT AVE STE 419
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3546
Practice Address - Country:US
Practice Address - Phone:360-863-2934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60151170251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health