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NPI Code Detail

MEDICARE: ROOT AND BLOOM COUNSELING

MEDICARE: ROOT AND BLOOM 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1952174476
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROOT AND BLOOM COUNSELING
Provider Business Mailing Address
First Line : 1216 SAINT ANDREW ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-4473
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 528 QUINCY ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-3628
Country : US
Telephone Number : 605-517-2005
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JENNIFER RAE PETERS
Credential : MA, LPC-MH
Telephone Number : 605-517-2005
Provider Enumeration Date : 11/06/2023
Last Update Date : 10/09/2025

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Directions to “ROOT AND BLOOM COUNSELING ” Practice Location

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