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General NPI Number Information
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NPI Number | 1811782188
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Entity Type | Organization
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Legal Business Name | ROOTED RESILIENCE WELLNESS PLLC
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 2200 S ORCHARD ST STE 201
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City | BOISE
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State | ID
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Zip | 83705-3713
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Country | US
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Telephone | 986-235-7612
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 W OWYHEE ST
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City | KUNA
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State | ID
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Zip | 83634-2207
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Country | US
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Telephone | 986-235-7612
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST, OWNER
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Name | LAURA MORELL
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Credential | LCSW
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Telephone | 986-235-7612
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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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