Provider Demographics
NPI:1699591479
Name:HEALING ROOTS THERAPY, LLC
Entity type:Organization
Organization Name:HEALING ROOTS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGRAV
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CADC
Authorized Official - Phone:319-573-6461
Mailing Address - Street 1:1322 NW BENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-7210
Mailing Address - Country:US
Mailing Address - Phone:319-573-6461
Mailing Address - Fax:
Practice Address - Street 1:1601 WESTLAKES PKWY STE 210
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8398
Practice Address - Country:US
Practice Address - Phone:319-573-6461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty