Healthcare Provider Details

I. General information

NPI: 1720997620
Provider Name (Legal Business Name): ROOTED GROWTH BEHAVIORAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 SPRING HILL LAKE LOOP
CAPE CORAL FL
33993-4528
US

IV. Provider business mailing address

400 N TAMPA ST STE 1550 #765978
TAMPA FL
33602
US

V. Phone/Fax

Practice location:
  • Phone: 813-753-8433
  • Fax:
Mailing address:
  • Phone: 813-753-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MACKENZIE MCDOUGALL
Title or Position: OWNER AND FOUNDER
Credential: MSW, LCSW
Phone: 813-753-8433