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Organization
WILD ROOTS THERAPEUTICS
Active
Organization
WILD ROOTS THERAPEUTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAMIE TISUE LCSW (OWNER, CLINICIAN)
(719) 752-5672
Entity
Organization
Contact information
Practice address
134 F ST STE 201, SALIDA, CO 81201-2160
(720) 443-4933
Mailing address
134 F ST STE 201, SALIDA, CO 81201-2160
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
04/23/2024
Last updated
08/06/2026
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