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Organization

WILD ROOTS PSYCHOTHERAPY & FAMILY COUNSELING, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANDIE TRAN (CEO/OWNER)
(951) 460-0005
Entity
Organization

Contact information

Practice address
35 HARRINGTON AVE UNIT 1316, SHREWSBURY, MA 01545-5277
(951) 460-0005
Mailing address
945 MORNING STAR DR, SONORA, CA 95370-9249

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
261QM0850X
Adult Mental Health Clinic/Center

Other

Enumeration date
12/05/2023
Last updated
12/05/2023
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