Organization
RACHEL ROOT PHD LP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RACHEL ANNE ROOT PHD (PRESIDENT)
(208) 344-2071
Entity
Organization
Contact information
Practice address
671 E RIVERPARK LN STE 220, BOISE, ID 83706
(208) 344-2071
(208) 344-2075
Mailing address
671 E RIVERPARK LN STE 220, BOISE, ID 83706-6559
(208) 344-2071
(208) 344-2075
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
PSY-202658
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12239758
CAQH
ID
01
—
1710279807
INDIVIDUAL - TYPE I NPI
ID
Enumeration date
10/11/2012
Last updated
07/26/2018
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