Healthcare Provider Details

I. General information

NPI: 1619893633
Provider Name (Legal Business Name): ROOTS AND WINGS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 E 200 N STE 201
ST GEORGE UT
84770-2869
US

IV. Provider business mailing address

225 N COUNTRY LN UNIT 15
ST GEORGE UT
84770-8416
US

V. Phone/Fax

Practice location:
  • Phone: 972-832-2411
  • Fax:
Mailing address:
  • Phone: 972-832-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANGELEE BAILEY
Title or Position: OWNER
Credential: CMHC
Phone: 972-832-2411