Healthcare Provider Details

I. General information

NPI: 1073265633
Provider Name (Legal Business Name): ROOTED INSIGHTS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 106TH ST STE E
URBANDALE IA
50322-3742
US

IV. Provider business mailing address

2570 106TH ST STE E
URBANDALE IA
50322-3742
US

V. Phone/Fax

Practice location:
  • Phone: 319-512-7250
  • Fax:
Mailing address:
  • Phone: 515-446-7284
  • Fax: 515-349-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. CARMEN TILLMAN
Title or Position: MANAGING MEMBER
Credential: MA
Phone: 515-446-7284