Healthcare Provider Details

I. General information

NPI: 1114859808
Provider Name (Legal Business Name): UPROOT PROGRESSIVE, MARRIAGE AND FAMILY THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

786 BUTTON AVE
MANTECA CA
95336-8593
US

IV. Provider business mailing address

863 MISSION RIDGE DR
MANTECA CA
95337-8006
US

V. Phone/Fax

Practice location:
  • Phone: 209-278-5188
  • Fax:
Mailing address:
  • Phone: 716-410-6552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ERIC D WILLIAMS
Title or Position: CEO
Credential: LMFT
Phone: 716-410-6552