=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639049141
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROOTED AND FLOWING THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2025
-----------------------------------------------------
Last Update Date | 11/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6655 JACKSON RD UNIT 4
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48103-9538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-635-8580
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 181
-----------------------------------------------------
City | DEXTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48130-0181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-635-8580
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER/THERAPIST
-----------------------------------------------------
Name | MYRA LYNN SANIYAH
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 734-635-8580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------