Organization
ROOTED WILLOW THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELBY CRISTINE CARSON LPC (OWNER AND THERAPIST)
(989) 331-0045
Entity
Organization
Contact information
Practice address
330B S UNIVERSITY AVE, MOUNT PLEASANT, MI 48858-2525
(989) 331-0045
Mailing address
330B S UNIVERSITY AVE, MOUNT PLEASANT, MI 48858-2525
(899) 331-0045
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811460751
—
MI
Enumeration date
09/14/2022
Last updated
03/13/2023
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