Provider Demographics
NPI:1427764851
Name:ROOT & PATH LLC
Entity type:Organization
Organization Name:ROOT & PATH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ED S LMHC LMFT LPC
Authorized Official - Phone:479-579-0280
Mailing Address - Street 1:9 HATHERN LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-4509
Mailing Address - Country:US
Mailing Address - Phone:352-225-1436
Mailing Address - Fax:
Practice Address - Street 1:3401 SE MACY RD STE 13
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7841
Practice Address - Country:US
Practice Address - Phone:479-579-0280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)