Organization
ROOTED WELL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MACKENZIE FULLETON LCSW (OWNER/PSYCHOTHERAPIST)
(406) 209-4928
Entity
Organization
Contact information
Practice address
321 E MAIN ST STE 207, BOZEMAN, MT 59715-4731
(406) 209-4928
Mailing address
10542 PO BOX, BOZEMAN, MT 59719
(406) 209-4928
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
02/15/2024
Last updated
10/31/2024
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