Healthcare Provider Details

I. General information

NPI: 1033028501
Provider Name (Legal Business Name): ROOTED HEALING COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4847 CALIFORNIA AVE SW STE 100
SEATTLE WA
98116-4470
US

IV. Provider business mailing address

4847 CALIFORNIA AVE SW STE 100
SEATTLE WA
98116-4470
US

V. Phone/Fax

Practice location:
  • Phone: 425-931-6450
  • Fax:
Mailing address:
  • Phone: 425-931-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: TYSON BAILEY
Title or Position: PARTNER
Credential: PSYD ABPP
Phone: 425-931-6450