Healthcare Provider Details

I. General information

NPI: 1871412429
Provider Name (Legal Business Name): ROOTS AND WONDER COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 W HUNTINGTON DR APT 5111
ROGERS AR
72758
US

IV. Provider business mailing address

4021 W WALNUT ST # 1034
ROGERS AR
72756-1842
US

V. Phone/Fax

Practice location:
  • Phone: 870-847-0867
  • Fax:
Mailing address:
  • Phone: 870-847-0867
  • 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: KRISTY GOODWIN
Title or Position: OWNER
Credential: LPC
Phone: 870-847-0867