Provider Demographics
NPI:1699501585
Name:ROOTED MENTAL WELLNESS
Entity type:Organization
Organization Name:ROOTED MENTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:FRICKE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:970-260-4248
Mailing Address - Street 1:134 F ST STE 209
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2160
Mailing Address - Country:US
Mailing Address - Phone:719-204-4202
Mailing Address - Fax:877-483-3146
Practice Address - Street 1:134 F ST STE 209
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2160
Practice Address - Country:US
Practice Address - Phone:719-204-4202
Practice Address - Fax:877-483-3146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty