| Deep Roots Wellness, Llc | |
|
8081 Adams Ridge Rd Defiance OH 43512-9173 | |
| (419) 239-2113 | |
| (419) 239-2113 |
| Full Name | Deep Roots Wellness, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 8081 Adams Ridge Rd, Defiance, Ohio |
| Authorized Official Name and Position | Matthew Hollo (OWNER) |
| Authorized Official Contact | 4192392113 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Deep Roots Wellness, Llc 105 Westfield Ave Defiance OH 43512-1433 Ph: (419) 239-2113 | Deep Roots Wellness, Llc 8081 Adams Ridge Rd Defiance OH 43512-9173 Ph: (419) 239-2113 |
| NPI Number | 1942799515 |
|---|---|
| Provider Enumeration Date | 05/08/2018 |
| Last Update Date | 10/12/2020 |
| Certification Date | 10/12/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942799515 | NPI | - | NPPES |
| 0157085 | Medicaid | OH | |
| 0282598 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | E0600346 (Ohio) | Primary |
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