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General NPI Number Information
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NPI Number | 1528894573
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Entity Type | Organization
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Legal Business Name | WELL ROOTED COUNSELING LLC
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 4251 SHAMROCK DR
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City | VENICE
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State | FL
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Zip | 34293-5661
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Country | US
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Telephone | 719-985-7668
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Fax |
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Provider Business Mailing Address
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Address Line | 4251 SHAMROCK DR
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City | VENICE
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State | FL
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Zip | 34293-5661
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Country | US
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Telephone | 719-985-7668
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | LAURA ANN BELLAMY
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Credential | MA LMHC NCC
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Telephone | 719-985-7668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 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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