Healthcare Provider Details

I. General information

NPI: 1740985688
Provider Name (Legal Business Name): ROOTED & RISING COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 04/01/2023
Certification Date: 04/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 NORAD DR
BOX ELDER SD
57719-8114
US

IV. Provider business mailing address

3213 W MAIN ST # 123
RAPID CITY SD
57702-2314
US

V. Phone/Fax

Practice location:
  • Phone: 605-702-4731
  • Fax:
Mailing address:
  • Phone: 605-702-4731
  • 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: STEPHANIE BEARD
Title or Position: MENTAL HEALTH THERAPIST
Credential:
Phone: 605-702-4731