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General NPI Number Information
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NPI Number | 1861050072
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Entity Type | Organization
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Legal Business Name | HEALING ROOTS COUNSELING, LLC
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Dates
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Enumeration Date | 06/03/2019
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 220 S PINE ST STE 102
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City | SISTERS
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State | OR
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Zip | 97759-1670
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Country | US
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Telephone | 541-904-0083
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Fax | 541-508-4526
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Provider Business Mailing Address
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Address Line | 220 S PINE ST STE 102
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City | SISTERS
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State | OR
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Zip | 97759-1670
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Country | US
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Telephone | 541-904-0083
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Fax | 541-508-4526
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Authorized Official
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Title or Position | COUNSELOR
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Name | ANGELA K PYKE
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Credential | LPC
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Telephone | 541-904-0083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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