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General NPI Number Information
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NPI Number | 1033958475
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Entity Type | Organization
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Legal Business Name | ROOT & BLOOM THERAPY PLLC
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 1955 W HAMLIN RD STE 101
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-3338
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Country | US
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Telephone | 810-618-4374
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Fax |
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Provider Business Mailing Address
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Address Line | 1955 W HAMLIN RD STE 101
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-3338
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Country | US
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Telephone | 248-301-6455
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/COUNSELOR
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Name | JORDAN RILEY TASKER
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Credential | LPC
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Telephone | 810-618-4374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 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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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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