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General NPI Number Information
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NPI Number | 1184535239
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Entity Type | Organization
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Legal Business Name | ROOTS OF PURPOSE LLC
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 430 MILTON REID RD
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City | DERIDDER
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State | LA
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Zip | 70634-8142
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Country | US
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Telephone | 512-789-2833
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 LAVACA ST # 366
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City | AUSTIN
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State | TX
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Zip | 78701-1634
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Country | US
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Telephone | 512-789-2833
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KACEE KIETH JACKSON
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Credential |
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Telephone | 512-789-2833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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