Provider Demographics
NPI:1427846948
Name:WHOLESOME ROOTS THERAPY LLC
Entity type:Organization
Organization Name:WHOLESOME ROOTS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-239-2954
Mailing Address - Street 1:4071 ROXBURY CIR # B
Mailing Address - Street 2:
Mailing Address - City:HILL AFB
Mailing Address - State:UT
Mailing Address - Zip Code:84056-1226
Mailing Address - Country:US
Mailing Address - Phone:951-239-2954
Mailing Address - Fax:
Practice Address - Street 1:4071 ROXBURY CIR # B
Practice Address - Street 2:
Practice Address - City:HILL AFB
Practice Address - State:UT
Practice Address - Zip Code:84056-1226
Practice Address - Country:US
Practice Address - Phone:951-239-2954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty