MEDICARE: ROOTED IN RESILIENCE HEALING ARTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1083411011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTED IN RESILIENCE HEALING ARTS

Provider Business Mailing Address
First Line	:	5154 SANTA ROSA ST
Second Line	:
City	:	MILTON
State	:	FL
Zip	:	32570-5917
Country	:	US
Telephone Number	:	850-776-8378
Fax Number	:

Provider Business Practice Location Address
First Line	:	5154 SANTA ROSA ST
Second Line	:
City	:	MILTON
State	:	FL
Zip	:	32570-5917
Country	:	US
Telephone Number	:	850-776-8378
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JENI SENTER
Credential	:	LMHC
Telephone Number	:	850-776-8378

Provider Enumeration Date	:	02/27/2025
Last Update Date	:	02/27/2025

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