MEDICARE: ROOT & RISE THERAPY AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1124917646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOT & RISE THERAPY AND WELLNESS

Provider Business Mailing Address
First Line	:	5032 LEONA ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-3322
Country	:	US
Telephone Number	:	314-498-3677
Fax Number	:

Provider Business Practice Location Address
First Line	:	5032 LEONA ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-3322
Country	:	US
Telephone Number	:	314-498-3677
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	ASIA ROBINSON
Credential	:	LPC
Telephone Number	:	314-498-3677

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	06/30/2025

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