Organization
ROOTS AND WINGS COUNSELING WILLOW TREE WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA RANDLES LCSW (OWNER)
(406) 203-6937
Entity
Organization
Contact information
Practice address
415 N HIGGINS AVE, SUITE 122, MISSOULA, MT 59802-4557
(406) 203-6937
(844) 965-9168
Mailing address
415 N HIGGINS AVE, SUITE 122, MISSOULA, MT 59802-4557
(406) 203-6937
(844) 965-9168
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7134
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043632177
NPI AS INDIVIDUAL
MT
Enumeration date
11/23/2015
Last updated
12/04/2015
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