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General NPI Number Information
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NPI Number | 1639083512
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Entity Type | Organization
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Legal Business Name | ROOTS MENTAL HEALTH COLLECTIVE
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 2601 N CAREER AVE APT 271
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City | SIOUX FALLS
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State | SD
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Zip | 57107-1376
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Country | US
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Telephone | 605-254-8026
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 N CAREER AVE APT 271
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City | SIOUX FALLS
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State | SD
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Zip | 57107-1376
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Country | US
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Telephone | 605-254-8026
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVIDA RUSSELL
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Credential |
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Telephone | 605-254-8026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | NULL
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