Organization
GOLDEN ROOTS THERAPY, LLC
Active
Other names
Golden Roots Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
JENNA HERTAUS LPCC (OWNER)
(612) 662-3989
Entity
Organization
Contact information
Practice address
1614 MAHTOMEDI AVE, MAHTOMEDI, MN 55115-1909
(612) 662-3989
Mailing address
4707 HIGHWAY 61 N STE 61, SAINT PAUL, MN 55110-3227
(612) 662-3989
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/27/2024
Last updated
06/27/2024
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