Healthcare Provider Details

I. General information

NPI: 1689539280
Provider Name (Legal Business Name): HEALING ROOTS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W LAKES PKWY
WEST DES MOINES IA
50266-8230
US

IV. Provider business mailing address

1322 NW BENNINGTON DR
WAUKEE IA
50263-7210
US

V. Phone/Fax

Practice location:
  • Phone: 319-573-6461
  • Fax: 515-855-3201
Mailing address:
  • Phone: 319-573-6461
  • Fax: 515-855-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEANNA ENGRAV
Title or Position: OWNER
Credential: LMFT
Phone: 319-573-6461