MEDICARE: TRUE ROOTS BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	106S00000X	Behavior Technician
3	171M00000X	Case Manager/Care Coordinator
4	175T00000X	Peer Specialist
5	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1124961990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE ROOTS BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	100 N HOWARD ST STE R
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0508
Country	:	US
Telephone Number	:	206-567-8990
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N HOWARD ST STE R
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0508
Country	:	US
Telephone Number	:	206-567-8990
Fax Number	:

Authorized Official
Title or Position	:	SUBSTANCE USE DISORDER PROFESSIONAL
Name	:	CANDYCE JACKSON
Credential	:	CDP.CP.61662333
Telephone Number	:	951-239-8784

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “TRUE ROOTS BEHAVIORAL HEALTH ” Practice Location

Language	Start Address	Practice Location

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