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General NPI Number Information
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NPI Number | 1720997620
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Entity Type | Organization
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Legal Business Name | ROOTED GROWTH BEHAVIORAL SERVICES PLLC
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Dates
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Enumeration Date | 09/04/2026
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Last Update Date | 09/04/2026
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Provider Practice Location Address
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Address Line | 374 SPRING HILL LAKE LOOP
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City | CAPE CORAL
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State | FL
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Zip | 33993-4528
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Country | US
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Telephone | 813-753-8433
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Fax |
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Provider Business Mailing Address
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Address Line | 400 N TAMPA ST STE 1550 #765978
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City | TAMPA
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State | FL
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Zip | 33602
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Country | US
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Telephone | 813-753-8433
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Fax |
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Authorized Official
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Title or Position | OWNER AND FOUNDER
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Name | MACKENZIE MCDOUGALL
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Credential | MSW, LCSW
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Telephone | 813-753-8433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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