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General NPI Number Information
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NPI Number | 1699662460
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Entity Type | Organization
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Legal Business Name | ROOTED MIND THERAPY LLC
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 7605 N HIGHLAND AVE
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City | TAMPA
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State | FL
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Zip | 33604-4031
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Country | US
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Telephone | 813-308-9788
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Fax |
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Provider Business Mailing Address
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Address Line | 7605 N HIGHLAND AVE
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City | TAMPA
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State | FL
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Zip | 33604-4031
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Country | US
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Telephone | 813-308-9788
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | HALEY JUHAYNA CORNISH
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Credential | MA, LMHC, CRC
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Telephone | 813-308-9788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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