Organization
AUTHENTIC ROOTS THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA WIRTH LMFT (CEO)
(612) 799-6652
Entity
Organization
Contact information
Practice address
7077 NORTHLAND CIR N STE 330, MINNEAPOLIS, MN 55428-1567
(612) 799-6652
Mailing address
11711 55TH ST NE, ALBERTVILLE, MN 55301-9745
(612) 799-6652
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7416210
—
MN
Enumeration date
04/22/2021
Last updated
08/10/2021
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