Healthcare Provider Details

I. General information

NPI: 1093581803
Provider Name (Legal Business Name): ROOTED COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 NE CHIPMAN RD
LEES SUMMIT MO
64063-2404
US

IV. Provider business mailing address

204 NE CHIPMAN RD
LEES SUMMIT MO
64063-2404
US

V. Phone/Fax

Practice location:
  • Phone: 816-682-1590
  • Fax:
Mailing address:
  • Phone: 816-682-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA GINTHER
Title or Position: OWNER/THERAPIST
Credential: LPC
Phone: 816-682-1590