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General NPI Number Information
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NPI Number | 1750016390
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Entity Type | Organization
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Legal Business Name | ROOTED PSYCHIATRY AND WELLNESS
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 507 W FOOTHILL BLVD
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City | MONROVIA
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State | CA
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Zip | 91016-2021
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Country | US
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Telephone | 818-809-0991
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Fax | 818-533-9540
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Provider Business Mailing Address
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Address Line | 161 W ALTADENA DR # 1001
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City | ALTADENA
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State | CA
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Zip | 91001-4735
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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 | CEO
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Name | ALYSHA WOODS
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Credential | PMHNP-BC
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Telephone | 818-809-0991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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