Provider Demographics
NPI:1538935820
Name:DEEP ROOTS COUNSELING INC.
Entity type:Organization
Organization Name:DEEP ROOTS COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:406-299-3768
Mailing Address - Street 1:1720 FOUR MILE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-0907
Mailing Address - Country:US
Mailing Address - Phone:406-299-3768
Mailing Address - Fax:
Practice Address - Street 1:1720 FOUR MILE VIEW RD
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-0907
Practice Address - Country:US
Practice Address - Phone:406-299-3768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)