Provider Demographics
NPI:1659163764
Name:ROOTED WILLOW COUNSELING, LLC
Entity type:Organization
Organization Name:ROOTED WILLOW COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:COUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:440-987-9008
Mailing Address - Street 1:1720 COOPER FOSTER PARK RD W STE A
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4200
Mailing Address - Country:US
Mailing Address - Phone:440-987-9008
Mailing Address - Fax:
Practice Address - Street 1:1720 COOPER FOSTER PARK RD W STE A
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4200
Practice Address - Country:US
Practice Address - Phone:440-987-9008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)