MEDICARE: ROOTS & WINGS COUNSELING SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1619859410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTS & WINGS COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	317 W CHERRY AVE APT A
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-5103
Country	:	US
Telephone Number	:	208-403-0039
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 W CHERRY AVE APT A
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-5103
Country	:	US
Telephone Number	:	208-403-0039
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CHRISTINA DAWN COLISTRO
Credential	:	LPC
Telephone Number	:	509-863-3510

Provider Enumeration Date	:	07/23/2025
Last Update Date	:	03/26/2026

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