Healthcare Provider Details

I. General information

NPI: 1831004696
Provider Name (Legal Business Name): ROOTED & RISING THERAPY COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 N MASON ST
SAGINAW MI
48602-5208
US

IV. Provider business mailing address

2228 N MASON ST
SAGINAW MI
48602-5208
US

V. Phone/Fax

Practice location:
  • Phone: 989-372-4053
  • Fax:
Mailing address:
  • Phone: 989-477-0858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TEY'ARIANA MO'NAYE MARSHALL-BROADEN
Title or Position: OWNER
Credential: LMSW
Phone: 989-372-4053