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NPI Code Detail

MEDICARE: MINDFUL ROOTS COUNSELING SERVICES LLC

MEDICARE: MINDFUL ROOTS COUNSELING SERVICES LLC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1306527908
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINDFUL ROOTS COUNSELING SERVICES LLC
Provider Business Mailing Address
First Line : 634 S ROOSEVELT ST STE 4
Second Line :
City : ABERDEEN
State : SD
Zip : 57401-6593
Country : US
Telephone Number : 605-846-7038
Fax Number : 605-401-4087
Provider Business Practice Location Address
First Line : 634 S ROOSEVELT ST STE 4
Second Line :
City : ABERDEEN
State : SD
Zip : 57401-6593
Country : US
Telephone Number : 605-846-7038
Fax Number : 605-401-4087
Authorized Official
Title or Position : OWNER
Name : BECKY SCHULDT
Credential : LPC-MH
Telephone Number : 605-846-7038
Provider Enumeration Date : 07/26/2023
Last Update Date : 07/29/2024

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Directions to “MINDFUL ROOTS COUNSELING SERVICES LLC ” Practice Location

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