{
"Npi": {
"NPI": "1639083512",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ROOTS MENTAL HEALTH COLLECTIVE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2601 N CAREER AVE APT 271",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SIOUX FALLS",
"MailingAddressStateName": "SD",
"MailingAddressPostalCode": "57107-1376",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "605-254-8026",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2601 N CAREER AVE APT 271",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SIOUX FALLS",
"PracticeLocationAddressStateName": "SD",
"PracticeLocationAddressPostalCode": "57107-1376",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "605-254-8026",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/29/2026",
"LastUpdateDate": "09/29/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RUSSELL",
"AuthorizedOfficialFirstName": "DAVIDA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "605-254-8026",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": null,
"LicenseNumberStateCode": "NULL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}