MEDICARE: ROOTS & RESILIENCE

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1992514442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTS & RESILIENCE

Provider Business Mailing Address
First Line	:	2002 N 22ND AVE STE 1
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-3153
Country	:	US
Telephone Number	:	406-579-4984
Fax Number	:

Provider Business Practice Location Address
First Line	:	2002 N 22ND AVE STE 1
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-3153
Country	:	US
Telephone Number	:	406-579-4984
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	ANNIE SULLIVAN
Credential	:
Telephone Number	:	406-285-1730

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	12/30/2024

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Directions to “ROOTS & RESILIENCE ” Practice Location

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