Healthcare Provider Details

I. General information

NPI: 1972415487
Provider Name (Legal Business Name): ROOT TO RISE COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 MOEN AVE
ROCKDALE IL
60436-9333
US

IV. Provider business mailing address

1821 MOEN AVE
ROCKDALE IL
60436-9333
US

V. Phone/Fax

Practice location:
  • Phone: 214-799-7182
  • Fax:
Mailing address:
  • Phone: 214-799-7182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: NICOLAS BELLEGARDE
Title or Position: PRESIDENT
Credential:
Phone: 214-799-7182