Provider Demographics
NPI:1588172068
Name:ROOTS COUNSELING AND ASSESSMENTS
Entity type:Organization
Organization Name:ROOTS COUNSELING AND ASSESSMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-201-8689
Mailing Address - Street 1:359 W 900 N
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-5119
Mailing Address - Country:US
Mailing Address - Phone:801-201-8689
Mailing Address - Fax:
Practice Address - Street 1:1760 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-7775
Practice Address - Country:US
Practice Address - Phone:435-359-2460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8367569-6004101YM0800X
UT8378553-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty