Healthcare Provider Details

I. General information

NPI: 1083557227
Provider Name (Legal Business Name): ROOT AND BLOOM THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 HIWOOD AVE
MUNROE FALLS OH
44262-1246
US

IV. Provider business mailing address

337 HIWOOD AVE
MUNROE FALLS OH
44262-1246
US

V. Phone/Fax

Practice location:
  • Phone: 330-697-9273
  • Fax: 234-678-4970
Mailing address:
  • Phone: 330-697-9273
  • Fax: 234-678-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JORDAN BREEDLOVE
Title or Position: OWNER
Credential: LPCC-S
Phone: 330-697-9273