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General NPI Number Information
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NPI Number | 1568324150
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Entity Type | Organization
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Legal Business Name | WELL ROOTED THERAPY SERVICES LLC
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 2426 S SHADOW GROVE CT
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City | BLOOMINGTON
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State | IN
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Zip | 47401-4334
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Country | US
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Telephone | 812-269-6332
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Fax |
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Provider Business Mailing Address
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Address Line | 2426 S SHADOW GROVE CT
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City | BLOOMINGTON
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State | IN
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Zip | 47401-4334
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MIRIAM SELAH KATZ
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Credential | LMFT PMH-C
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Telephone | 812-361-8105
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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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