Healthcare Provider Details

I. General information

NPI: 1760397459
Provider Name (Legal Business Name): ROOT & RISE MENTAL HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 NICKLAUS CT
FULTON MO
65251
US

IV. Provider business mailing address

115 CONLEY RD # 1031
COLUMBIA MO
65201-6465
US

V. Phone/Fax

Practice location:
  • Phone: 573-200-6698
  • Fax:
Mailing address:
  • Phone: 573-200-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LISA HAGLUND
Title or Position: THERAPIST
Credential: LCSW
Phone: 573-619-1263