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General NPI Number Information
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NPI Number | 1013653187
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Entity Type | Organization
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Legal Business Name | SOULFULLY ROOTED WELLNESS PLLC
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 4324 MAPLESHADE LN # 248
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City | PLANO
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State | TX
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Zip | 75093-0050
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Country | US
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Telephone | 469-333-1596
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Fax |
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Provider Business Mailing Address
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Address Line | 4324 MAPLESHADE LN # 248
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City | PLANO
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State | TX
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Zip | 75093-0050
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Country | US
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Telephone | 469-333-1596
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COURTNEY BUTTS
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Credential |
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Telephone | 469-333-1596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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