| Roots Therapy Nw Llc | |
|
6030 Se 52nd Ave Ste 204 Portland OR 97206-6801 | |
| (971) 291-9947 | |
| (503) 974-6689 |
| Full Name | Roots Therapy Nw Llc |
|---|---|
| Speciality | Counselor |
| Location | 6030 Se 52nd Ave Ste 204, Portland, Oregon |
| Authorized Official Name and Position | Julia Bryson (MEMBER) |
| Authorized Official Contact | 5039229026 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Roots Therapy Nw Llc 6030 Se 52nd Ave Ste 204 Portland OR 97206-6801 Ph: (971) 291-9947 | Roots Therapy Nw Llc 6030 Se 52nd Ave Ste 204 Portland OR 97206-6801 Ph: (971) 291-9947 |
| NPI Number | 1831789098 |
|---|---|
| Provider Enumeration Date | 01/21/2021 |
| Last Update Date | 08/16/2021 |
| Certification Date | 08/16/2021 |
| Medicare PECOS PAC ID | 5395140222 |
|---|---|
| Medicare Enrollment ID | O20210816002448 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831789098 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Julia Amy Hill Bryson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457537128 PECOS PAC ID: 1456614221 Enrollment ID: I20180409000406 |
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