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General NPI Number Information
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NPI Number | 1962242750
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Entity Type | Organization
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Legal Business Name | ROOTED WELL, LLC
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 21370 SW LANGER FARMS PKWY STE 142-111
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City | SHERWOOD
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State | OR
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Zip | 97140-9137
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Country | US
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Telephone | 971-990-8177
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Fax |
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Provider Business Mailing Address
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Address Line | 21370 SW LANGER FARMS PKWY STE 142-111
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City | SHERWOOD
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State | OR
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Zip | 97140-9137
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Country | US
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Telephone | 971-990-8177
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. BOBBY TRIHUB
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Credential | PSYD
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Telephone | 971-990-8177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 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 #3
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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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