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General NPI Number Information
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NPI Number | 1275342867
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Entity Type | Organization
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Legal Business Name | FAMILY ROOTZ LLC
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 11242 N 1175 W
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City | MONTICELLO
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State | IN
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Zip | 47960-8103
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Country | US
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Telephone | 574-297-1193
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 41
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City | MONTICELLO
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State | IN
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Zip | 47960-0041
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Country | US
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Telephone | 574-297-1193
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | BROOKE JOHNSON
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Credential |
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Telephone | 574-297-1193
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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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