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NPI Code Detail

MEDICARE: ROOTS RENEWAL COUNSELING

MEDICARE: ROOTS RENEWAL COUNSELING
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1811492077
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROOTS RENEWAL COUNSELING
Provider Business Mailing Address
First Line : 11042 MANCHESTER RD
Second Line :
City : KIRKWOOD
State : MO
Zip : 63122-1244
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11042 MANCHESTER RD
Second Line :
City : KIRKWOOD
State : MO
Zip : 63122-1244
Country : US
Telephone Number : 402-280-2735
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : STEPHANIE STOCKHAM-RONOLLO
Credential : LPC
Telephone Number : 402-280-2735
Provider Enumeration Date : 03/28/2018
Last Update Date : 03/28/2018

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Directions to “ROOTS RENEWAL COUNSELING ” Practice Location

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