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General NPI Number Information
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NPI Number | 1750243002
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Entity Type | Organization
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Legal Business Name | WELL ROOTED INTEGRATIVE THERAPY PLLC
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Dates
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Enumeration Date | 11/25/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 1191 E IRON EAGLE DR STE 100
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City | EAGLE
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State | ID
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Zip | 83616-5139
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Country | US
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Telephone | 208-314-8655
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Fax |
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Provider Business Mailing Address
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Address Line | 3770 E AMITY AVE UNIT 105
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City | NAMPA
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State | ID
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Zip | 83687-1194
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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 | OWNER
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Name | DR. JENNIFER MCWATERS
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Credential | PSY.D.
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Telephone | 208-314-8655
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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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