| Rooted In Change, Llc | |
|
422 W Spruce St Stop C Missoula MT 59802-4141 | |
| (858) 868-0364 | |
| Not Available |
| Full Name | Rooted In Change, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 422 W Spruce St Stop C, Missoula, Montana |
| Authorized Official Name and Position | Angela Petersen (PSYCHOLOGIST) |
| Authorized Official Contact | 8588680364 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rooted In Change, Llc Po Box 16592 Missoula MT 59808-6592 Ph: (858) 868-0364 | Rooted In Change, Llc 422 W Spruce St Stop C Missoula MT 59802-4141 Ph: (858) 868-0364 |
| NPI Number | 1912775065 |
|---|---|
| Provider Enumeration Date | 12/18/2023 |
| Last Update Date | 12/18/2023 |
| Certification Date | 12/18/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912775065 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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