Healthcare Provider Details

I. General information

NPI: 1639004625
Provider Name (Legal Business Name): SEEDS TO ROOTS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5216 WESTWIND ST NE
ALBUQUERQUE NM
87111-5705
US

IV. Provider business mailing address

11318 OVERLOOK DR NE
ALBUQUERQUE NM
87111-5711
US

V. Phone/Fax

Practice location:
  • Phone: 818-426-8984
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DARA ZAFRAN
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSY.D
Phone: 818-426-8984