Healthcare Provider Details

I. General information

NPI: 1801593348
Provider Name (Legal Business Name): DEEPLY ROOTED PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 09/15/2024
Certification Date: 09/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 US 1 STE 206
NORTH PALM BEACH FL
33408-3865
US

IV. Provider business mailing address

860 US 1 STE 206
NORTH PALM BEACH FL
33408-3865
US

V. Phone/Fax

Practice location:
  • Phone: 321-345-7339
  • Fax:
Mailing address:
  • Phone: 321-345-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERIN MCKINNEY
Title or Position: PSYCHOTHERAPIST/OWNER
Credential: LCSW, RPT
Phone: 321-345-7339