Healthcare Provider Details

I. General information

NPI: 1912858135
Provider Name (Legal Business Name): HEALING ROOTS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1789 E SKYLINE DR UNIT H6
EAGLE MOUNTAIN UT
84005-6541
US

IV. Provider business mailing address

1789 E SKYLINE DR UNIT H6
EAGLE MOUNTAIN UT
84005-6541
US

V. Phone/Fax

Practice location:
  • Phone: 385-246-3110
  • Fax:
Mailing address:
  • Phone: 385-246-3110
  • 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: HANNAH OSTLER
Title or Position: THERAPIST
Credential: LCSW
Phone: 385-246-3110