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General NPI Number Information
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NPI Number | 1730981242
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Entity Type | Organization
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Legal Business Name | ROOTS & REFUGE CENTER LLC
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 5900 BALCONES DR STE 100
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City | AUSTIN
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State | TX
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Zip | 78731-4298
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Country | US
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Telephone | 737-369-9700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 460074
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City | ESCONDIDO
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State | CA
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Zip | 92046-0074
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICERS (CEOS)
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Name | ANGELIQUE UMUTESI
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Credential | LCSW
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Telephone | 737-369-9700
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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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