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General NPI Number Information
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NPI Number | 1538935820
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Entity Type | Organization
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Legal Business Name | DEEP ROOTS COUNSELING INC.
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 1720 FOUR MILE VIEW RD
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City | BUTTE
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State | MT
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Zip | 59701-0907
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Country | US
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Telephone | 406-299-3768
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 FOUR MILE VIEW RD
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City | BUTTE
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State | MT
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Zip | 59701-0907
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Country | US
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Telephone | 406-299-3768
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | BERNADETTE MARIE REYNOLDS
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Credential | LCPC
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Telephone | 406-299-3768
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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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