Provider Demographics
NPI:1336964527
Name:MINDFUL ROOTS WELLNESS PLLC
Entity type:Organization
Organization Name:MINDFUL ROOTS WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:509-724-0152
Mailing Address - Street 1:5706 17TH AVE NW UNIT 17509
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98127-1650
Mailing Address - Country:US
Mailing Address - Phone:509-724-0152
Mailing Address - Fax:
Practice Address - Street 1:108 S JACKSON ST STE 301
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2872
Practice Address - Country:US
Practice Address - Phone:509-724-0152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health