Provider Demographics
NPI:1962242750
Name:ROOTED WELL, LLC
Entity type:Organization
Organization Name:ROOTED WELL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIHUB
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:971-990-8177
Mailing Address - Street 1:21370 SW LANGER FARMS PKWY STE 142-111
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9137
Mailing Address - Country:US
Mailing Address - Phone:971-990-8177
Mailing Address - Fax:
Practice Address - Street 1:21370 SW LANGER FARMS PKWY STE 142-111
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9137
Practice Address - Country:US
Practice Address - Phone:971-990-8177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty