Healthcare Provider Details

I. General information

NPI: 1194319749
Provider Name (Legal Business Name): REROOTED COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 E 18TH AVE
DENVER CO
80206-1108
US

IV. Provider business mailing address

635 S GLENCOE ST
DENVER CO
80246-1402
US

V. Phone/Fax

Practice location:
  • Phone: 720-933-2219
  • Fax:
Mailing address:
  • Phone: 720-933-2219
  • Fax: 303-648-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LAUREN SHELTON
Title or Position: OWNER
Credential:
Phone: 720-933-2219