| Wild Roots Somatic Therapy | |
|
134 F St Ste 209 Salida CO 81201-2160 | |
| (720) 443-4933 | |
| Not Available |
| Full Name | Wild Roots Somatic Therapy |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 134 F St Ste 209, Salida, Colorado |
| Authorized Official Name and Position | Mamie Tisue (OWNER, CLINICIAN) |
| Authorized Official Contact | 7204434933 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Roots Somatic Therapy Po Box 1355 Salida CO 81201-1355 Ph: () - | Wild Roots Somatic Therapy 134 F St Ste 209 Salida CO 81201-2160 Ph: (720) 443-4933 |
| NPI Number | 1922853779 |
|---|---|
| Provider Enumeration Date | 04/23/2024 |
| Last Update Date | 05/15/2024 |
| Certification Date | 05/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922853779 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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