Authentic Roots Therapy PLLC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

AUTHENTIC ROOTS THERAPY PLLC

Practice address

7077 Northland Cir N Ste 330
Minneapolis, MN 55428-1567

Phone

(612) 799-6652

NPI assigned

Apr 22, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amanda Wirth, LMFTNPI 1215324074

Title

Ceo

Phone

(612) 799-6652

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amanda Adell Wirth, LMFT

  • Marriage & Family Therapist
  • Minneapolis, MN
  • NPI 1215324074
  NPD Authorized official
• Douglas P. Robinson, MA LMFT

  • Marriage & Family Therapist
  • Minneapolis, MN
  • NPI 1033886924
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628553600000",
    "number": "1346822046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11711 55TH ST NE",
            "city": "ALBERTVILLE",
            "state": "MN",
            "postal_code": "553019745",
            "telephone_number": "612-799-6652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7077 NORTHLAND CIR N STE 330",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554281567",
            "telephone_number": "612-799-6652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTHENTIC ROOTS THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-22",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "WIRTH",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "612-799-6652",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7416210",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Austin, LICSW
• Misty Rose Austin, PT
• Rebekah Pulju Austin
• Rupa Polam Austria, MD
• Authentic Living Services LLC
• Authentic Therapeutic Services L.L.C.
• Autism Ability Center LLC
• Autism Ability Center LLC
• Autism Behavioral Center LLC
• Autism Bright Start

• Marriage & Family Therapist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.