MEDICARE: WELL ROOTED THERAPY 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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1568324150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELL ROOTED THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	2426 S SHADOW GROVE CT
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-4334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2426 S SHADOW GROVE CT
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-4334
Country	:	US
Telephone Number	:	812-269-6332
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MIRIAM SELAH KATZ
Credential	:	LMFT PMH-C
Telephone Number	:	812-361-8105

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “WELL ROOTED THERAPY SERVICES LLC ” Practice Location

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