Provider Demographics
NPI:1609614643
Name:ROOTBOUND THERAPY, LLC
Entity type:Organization
Organization Name:ROOTBOUND THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRANDENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:805-705-9671
Mailing Address - Street 1:PO BOX 1094
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-1094
Mailing Address - Country:US
Mailing Address - Phone:805-705-9671
Mailing Address - Fax:
Practice Address - Street 1:32 PEA PL
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-8302
Practice Address - Country:US
Practice Address - Phone:805-705-9671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty