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General NPI Number Information
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NPI Number | 1023735321
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Entity Type | Organization
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Legal Business Name | ROOTED RECOVERY AND WELLNESS, LLC
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 5418 N EAGLE RD STE 160
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City | BOISE
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State | ID
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Zip | 83713-0100
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Country | US
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Telephone | 541-844-3577
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Fax |
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Provider Business Mailing Address
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Address Line | 85835 ALLBRITAIN LN
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City | EUGENE
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State | OR
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Zip | 97405-8403
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Country | US
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Telephone | 541-972-1891
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KATHERINE LYNN FRASER
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Credential | MS, LPC
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Telephone | 888-455-1642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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