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General NPI Number Information
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NPI Number | 1245029644
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Entity Type | Organization
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Legal Business Name | ROOTS OF GROWTH COUNSELING SERVICES, PLLC
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 4400 CHARLOTTE AVE APT 4303
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-4418
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Country | US
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Telephone | 682-268-4250
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 55
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City | HASLET
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State | TX
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Zip | 76052-0055
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Country | US
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Telephone | 682-268-4250
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MIATTA MORGAN
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Credential | LCSW
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Telephone | 682-268-4250
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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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