Healthcare Provider Details

I. General information

NPI: 1295470862
Provider Name (Legal Business Name): ROOT TO RISE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 06/16/2024
Certification Date: 06/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S MAIN ST STE B
ROCK SPRINGS WY
82901-6247
US

IV. Provider business mailing address

408 S MAIN ST STE B
ROCK SPRINGS WY
82901-6247
US

V. Phone/Fax

Practice location:
  • Phone: 307-374-4014
  • Fax:
Mailing address:
  • Phone: 307-374-4014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: JESSICA CASTILLO
Title or Position: COUNSELOR/OWNER
Credential: LPC
Phone: 307-374-4014