DEEP ROOTS WELLNESS LLC NPI 1942799515

NPI Information

NPI: 1942799515
Provider Name: DEEP ROOTS WELLNESS, LLC
Classification: Counselor - 101YM0800X
Entity Type: Organization

Specialization: Mental Health

Address:
8081 ADAMS RIDGE RD
DEFIANCE, OH
ZIP 43512
Phone: (419) 239-2113
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DEEP ROOTS WELLNESS, LLC is a mental health counselor in Defiance, OH. DEEP ROOTS WELLNESS, LLC NPI is 1942799515. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

8081 ADAMS RIDGE RD
DEFIANCE, OH
ZIP 43512-173
Phone: (419) 239-2113
Fax: (419) 239-2113

The provider's authorized official is Matthew Hollo .
The authorized official title is Owner and has the following contact phone number (419) 239-2113.

The enumeration date for this NPI number is 5/8/2018 and was last updated on 10/12/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health	E0600346	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0157085	MEDICAID	OHIO
2	0282598	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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