Healthcare Provider Details

I. General information

NPI: 1841187259
Provider Name (Legal Business Name): NEUROROOTED THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2912 N 26TH ST
TACOMA WA
98407-6305
US

IV. Provider business mailing address

2912 N 26TH ST
TACOMA WA
98407-6305
US

V. Phone/Fax

Practice location:
  • Phone: 206-659-1624
  • Fax: 206-971-9532
Mailing address:
  • Phone: 206-659-1624
  • Fax: 206-971-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHANIE L BECKER
Title or Position: OWNER, CLINICAL SOCIAL WORKER
Credential: LICSW
Phone: 206-659-1624