MEDICARE: SEEDS TO ROOTS THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TA0700X	Adult Development & Aging Psychologist
2	103TC2200X	Clinical Child & Adolescent Psychologist
3	103TH0004X	Health Psychologist
4	103TP2701X	Group Psychotherapy Psychologist
5	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1639004625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEEDS TO ROOTS THERAPY, LLC

Provider Business Mailing Address
First Line	:	11318 OVERLOOK DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-5711
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5216 WESTWIND ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-5705
Country	:	US
Telephone Number	:	818-426-8984
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	DARA ZAFRAN
Credential	:	PSY.D
Telephone Number	:	818-426-8984

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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