Provider Demographics
NPI:1063289023
Name:THE ROOT OF THE MATTER
Entity type:Organization
Organization Name:THE ROOT OF THE MATTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:972-365-0346
Mailing Address - Street 1:1310 PECAN LN
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-3270
Mailing Address - Country:US
Mailing Address - Phone:682-730-2816
Mailing Address - Fax:
Practice Address - Street 1:1106 SANTA FE TRL STE 4
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-3063
Practice Address - Country:US
Practice Address - Phone:682-730-2816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty