Healthcare Provider Details

I. General information

NPI: 1124872601
Provider Name (Legal Business Name): ROOTED RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E 9TH ST
OWENSBORO KY
42303-0337
US

IV. Provider business mailing address

1300 E 9TH ST
OWENSBORO KY
42303-0337
US

V. Phone/Fax

Practice location:
  • Phone: 270-297-7332
  • Fax:
Mailing address:
  • Phone: 270-297-7332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: ARVEL HARRIS
Title or Position: CLINICAL DIRECTOR
Credential: LPCC-S, LCADC, CCS
Phone: 270-313-5000