Provider Demographics
NPI:1982461281
Name:ROOTED IN SKY LLC
Entity Type:Organization
Organization Name:ROOTED IN SKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:K
Authorized Official - Last Name:THERRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT
Authorized Official - Phone:510-421-6400
Mailing Address - Street 1:619 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-3008
Mailing Address - Country:US
Mailing Address - Phone:510-421-6400
Mailing Address - Fax:
Practice Address - Street 1:4341 S WESTNEDGE AVE STE 2212
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3287
Practice Address - Country:US
Practice Address - Phone:510-421-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty