Healthcare Provider Details

I. General information

NPI: 1356263123
Provider Name (Legal Business Name): ROOTS AND RESILIENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6951 BOOT STRAP CT
CHEYENNE WY
82001-8569
US

IV. Provider business mailing address

6951 BOOT STRAP CT
CHEYENNE WY
82001-8569
US

V. Phone/Fax

Practice location:
  • Phone: 928-606-7433
  • Fax:
Mailing address:
  • Phone: 928-606-7433
  • 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: CECELIA ANN BAY
Title or Position: OWNER
Credential: LCSW
Phone: 928-606-7433