Healthcare Provider Details

I. General information

NPI: 1164358768
Provider Name (Legal Business Name): ROOTED COUNSELING & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W MOUNTAIN ST STE 301
FAYETTEVILLE AR
72701-6022
US

IV. Provider business mailing address

2321 N BLUE MESA DR
FAYETTEVILLE AR
72703-9383
US

V. Phone/Fax

Practice location:
  • Phone: 479-684-9928
  • Fax:
Mailing address:
  • Phone: 479-684-9928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY MASON
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 479-684-9928