MEDICARE: SACRED ROOTS COUNSELING AND TRAINING CENTER COMMA PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1194661553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED ROOTS COUNSELING AND TRAINING CENTER COMMA PLLC

Provider Business Mailing Address
First Line	:	581 PAN AMERICAN DR STE 7
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1960
Country	:	US
Telephone Number	:	254-399-5290
Fax Number	:

Provider Business Practice Location Address
First Line	:	581 PAN AMERICAN DR STE 7
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1960
Country	:	US
Telephone Number	:	254-399-5290
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER/COUNSELOR
Name	:	TIMOTHY POOL
Credential	:	LCSW
Telephone Number	:	254-399-5290

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	05/31/2026

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