Provider Demographics
NPI:1982116372
Name:ROOTS TO WILDFLOWERS, PLLC
Entity Type:Organization
Organization Name:ROOTS TO WILDFLOWERS, PLLC
Other - Org Name:DAWNING LIGHT COUNSELING, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MONCRIEF
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:469-617-2252
Mailing Address - Street 1:2301 OLYMPIA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1855
Mailing Address - Country:US
Mailing Address - Phone:469-617-2252
Mailing Address - Fax:
Practice Address - Street 1:2301 OLYMPIA DR STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1855
Practice Address - Country:US
Practice Address - Phone:469-617-2252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)