Roots and Wings Counseling Willow Tree Wellness LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

7134 Issued in MT

Legal business name

ROOTS AND WINGS COUNSELING WILLOW TREE WELLNESS LLC

Practice address

415 N Higgins Ave
Suite 122
Missoula, MT 59802-4557

Phone

(406) 203-6937

Fax

(844) 965-9168

NPI assigned

Nov 23, 2015

Organization subpart

No

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

Authorized official

Name

Cynthia Randles, LCSWNPI 1043632177

Title

Owner

Phone

(406) 203-6937

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MT

Enrollment records 1

Locations

Practitioners 1

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

• Cynthia Nicole Randles, LCSW

  • Social Worker
  • Missoula, MT
  • NPI 1043632177
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1448236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449187200000",
    "number": "1407220767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 N HIGGINS AVE",
            "address_2": "SUITE 122",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024557",
            "telephone_number": "406-203-6937",
            "fax_number": "844-965-9168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 N HIGGINS AVE",
            "address_2": "SUITE 122",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024557",
            "telephone_number": "406-203-6937",
            "fax_number": "844-965-9168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOTS AND WINGS COUNSELING WILLOW TREE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-23",
        "last_updated": "2015-12-04",
        "status": "A",
        "authorized_official_last_name": "RANDLES",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-203-6937",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MT",
            "license": "7134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI AS INDIVIDUAL",
            "identifier": "1043632177",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anna Roman, MD
• Ronald F Rosser DDS PC
• Diane Roosa, PT
• Pat Roosa
• Rooted in Change, LLC
• Roots Guidance and Counseling LLC
• Philip A. Roper, MD
• Samantha Rosaia, PA
• Rosauers Food and Drug #27
• Rosauers Supermarkets Inc (Rosauers Pharmacy)

• Clinical Social Worker in Missoula, MT
• Providers in Missoula, MT by specialty
• Clinical Social Worker in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.