Provider Demographics
NPI:1043015720
Name:ROOTED MINDRX
Entity type:Organization
Organization Name:ROOTED MINDRX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRAWFORD-JONAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-796-3064
Mailing Address - Street 1:5911 S WHITE PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5851
Mailing Address - Country:US
Mailing Address - Phone:602-796-3064
Mailing Address - Fax:
Practice Address - Street 1:25 S ARIZONA PL STE 500
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8520
Practice Address - Country:US
Practice Address - Phone:480-696-5576
Practice Address - Fax:866-613-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty