# DEEP ROOTS WELLNESS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942799515
- **Authorized official:** MATTHEW HOLLO LPCC-S (OWNER)
- **Authorized official phone:** (419) 239-2113

## Contact information

- **Practice address:** 8081 ADAMS RIDGE RD, DEFIANCE, OH 43512-9173
- **Practice address phone:** (419) 239-2113
- **Practice address fax:** (419) 239-2113
- **Mailing address:** 105 WESTFIELD AVE, DEFIANCE, OH 43512-1433
- **Mailing address phone:** (419) 239-2113

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | E0600346 | OH | Yes |

## Other

- **Enumeration date:** 05/08/2018
- **Last updated:** 10/12/2020