Provider Demographics
NPI:1043034994
Name:RESILIENT ROOTS THERAPY LLC
Entity type:Organization
Organization Name:RESILIENT ROOTS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMSW
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-795-9464
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-0074
Mailing Address - Country:US
Mailing Address - Phone:517-795-9464
Mailing Address - Fax:
Practice Address - Street 1:58 PARKLAND PLZ STE 300
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6208
Practice Address - Country:US
Practice Address - Phone:517-795-9464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty