MEDICARE: DEEPLY ROOTED COUNSELING, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1295672475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEEPLY ROOTED COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	412 N PARKHILL LOOP
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-9106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 N PARKHILL LOOP
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-9106
Country	:	US
Telephone Number	:	620-515-5599
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST / OWNER
Name	:	DR. MADISON WYANT
Credential	:	LPC, RPT
Telephone Number	:	620-515-5599

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

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