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General NPI Number Information
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NPI Number | 1699501585
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Entity Type | Organization
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Legal Business Name | ROOTED MENTAL WELLNESS
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 134 F ST STE 209
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City | SALIDA
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State | CO
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Zip | 81201-2160
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Country | US
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Telephone | 719-204-4202
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Fax | 877-483-3146
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Provider Business Mailing Address
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Address Line | 134 F ST STE 209
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City | SALIDA
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State | CO
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Zip | 81201-2160
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Country | US
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Telephone | 719-204-4202
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Fax | 877-483-3146
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | SCOTT FRICKE
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Credential | PMHNP
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Telephone | 970-260-4248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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