Provider Demographics
NPI:1932810868
Name:ROSEROOT COUNSELING AND CONSULTING, LTD.
Entity type:Organization
Organization Name:ROSEROOT COUNSELING AND CONSULTING, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LISW CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-306-4590
Mailing Address - Street 1:465 52ND PL
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2897
Mailing Address - Country:US
Mailing Address - Phone:515-306-4590
Mailing Address - Fax:
Practice Address - Street 1:6600 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50324-1639
Practice Address - Country:US
Practice Address - Phone:515-306-4590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty