Healthcare Provider Details

I. General information

NPI: 1326971912
Provider Name (Legal Business Name): WILLOWROOT WELLNESS COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SHADY CREEK LN
AMELIA OH
45102-1765
US

IV. Provider business mailing address

21 SHADY CREEK LN
AMELIA OH
45102-1765
US

V. Phone/Fax

Practice location:
  • Phone: 513-739-0289
  • Fax: 513-739-0289
Mailing address:
  • Phone: 513-739-0289
  • Fax: 513-739-0289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE LEE SWOPE
Title or Position: OWNER
Credential: M.ED., LPCC-S
Phone: 513-739-0289