Provider Demographics
NPI:1255966131
Name:ROOTS AND BRANCHES COUNSELING LLC
Entity type:Organization
Organization Name:ROOTS AND BRANCHES COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KARISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VIEBECK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-241-2252
Mailing Address - Street 1:61336 STARDRIFT DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2051
Mailing Address - Country:US
Mailing Address - Phone:503-804-2295
Mailing Address - Fax:
Practice Address - Street 1:29 NW GREELEY AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2911
Practice Address - Country:US
Practice Address - Phone:541-241-2252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)