Provider Demographics
NPI:1033958475
Name:ROOT & BLOOM THERAPY PLLC
Entity type:Organization
Organization Name:ROOT & BLOOM THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:RILEY
Authorized Official - Last Name:TASKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:810-618-4374
Mailing Address - Street 1:1955 W HAMLIN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3338
Mailing Address - Country:US
Mailing Address - Phone:248-301-6455
Mailing Address - Fax:
Practice Address - Street 1:1955 W HAMLIN RD STE 101
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3338
Practice Address - Country:US
Practice Address - Phone:810-618-4374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty