Profound Roots Therapy Services

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

PROFOUND ROOTS THERAPY SERVICES

Practice address

609 Lisa Road
West Dundee, IL 60118

Phone

(847) 565-1084

Fax

(847) 787-1746

NPI assigned

Jun 8, 2023

Organization subpart

No

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

Authorized official

Name

Nelicia ButlerNPI 1811407810

Title

Owner

Phone

(847) 565-1084

Specialties & licenses 1

Addresses

Practitioners 1

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

• Nelicia Butler

  • Professional Counselor
  • Bloomington, IL
  • NPI 1811407810
  NPD Authorized official

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

{
    "created_epoch": "1686182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1487348728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 S RANDALL RD STE 1134",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601235529",
            "telephone_number": "847-565-1084",
            "fax_number": "847-787-1746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 LISA ROAD",
            "city": "WEST DUNDEE",
            "state": "IL",
            "postal_code": "60118",
            "telephone_number": "847-565-1084",
            "fax_number": "847-787-1746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFOUND ROOTS THERAPY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-08",
        "last_updated": "2023-06-08",
        "certification_date": "2023-05-31",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "NELICIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-565-1084"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Deborah Pryor, LCPC
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• Natasha Ann Radnovich, MED
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• Cynthia Reyes Rivas

• Professional Counselor in West Dundee, IL
• Providers in West Dundee, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; 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.