Healthcare Provider Details

I. General information

NPI: 1497679112
Provider Name (Legal Business Name): DEEP ROOTS RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 ASPEN RD UNIT B
MAXWELL TX
78656-4338
US

IV. Provider business mailing address

202 ASPEN RD UNIT B
MAXWELL TX
78656-4338
US

V. Phone/Fax

Practice location:
  • Phone: 512-557-7832
  • Fax:
Mailing address:
  • Phone: 512-557-7832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EUGENE MILLER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 714-345-7856