MEDICARE: ROOT & RISE PSYCHOTHERAPY 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1578196317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOT & RISE PSYCHOTHERAPY PLLC

Provider Business Mailing Address
First Line	:	1484 ASHLAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-7433
Country	:	US
Telephone Number	:	612-423-2176
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 RAYMOND AVE STE 202
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1164
Country	:	US
Telephone Number	:	612-423-2176
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	SONJA KROMROY
Credential	:	MA, LPCC
Telephone Number	:	612-423-2176

Provider Enumeration Date	:	02/20/2020
Last Update Date	:	02/20/2020

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