Healthcare Provider Details

I. General information

NPI: 1164383212
Provider Name (Legal Business Name): WILDROOT COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 GRANT AVE # 212
OGDEN UT
84401-2308
US

IV. Provider business mailing address

4031 E 4475 N
EDEN UT
84310-9538
US

V. Phone/Fax

Practice location:
  • Phone: 435-531-1455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: KASSONDRA M MCADAMS
Title or Position: LCSW
Credential:
Phone: 435-531-1455