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General NPI Number Information
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NPI Number | 1073096780
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Entity Type | Organization
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Legal Business Name | ROOTED RELATIONAL THERAPY LLC
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Dates
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Enumeration Date | 09/09/2018
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 400 MARKET ST
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City | MIFFLINBURG
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State | PA
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Zip | 17844-1249
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Country | US
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Telephone | 570-884-4662
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 54
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City | MIFFLINBURG
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State | PA
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Zip | 17844-0054
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Country | US
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Telephone | 570-884-4662
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Fax |
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Authorized Official
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Title or Position | OWNER AND THERAPIST
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Name | DOUG RICHARD
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Credential | MAMFT
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Telephone | 570-884-4662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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