Healthcare Provider Details

I. General information

NPI: 1700713732
Provider Name (Legal Business Name): ROOTED IN HOPE COUNSELING, A LICENSED CLINICAL SOCIAL WORKER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3476 GALVESTON AVE
SIMI VALLEY CA
93063-1214
US

IV. Provider business mailing address

8605 SANTA MONICA BLVD PMB 671310
WEST HOLLYWOOD CA
90069-4109
US

V. Phone/Fax

Practice location:
  • Phone: 805-491-4375
  • Fax:
Mailing address:
  • Phone: 805-491-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL DE JESUSE ORTEGA
Title or Position: CEO
Credential: LCSW
Phone: 805-491-4375