Revive Roots, PLLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

REVIVE ROOTS, PLLC

Doing business as

Reviving Roots Therapy & Wellness

Practice address

3440 Portland Ave
Minneapolis, MN 55407-4861

Phone

(612) 990-8172

NPI assigned

Jan 13, 2020

Organization subpart

No

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

Authorized official

Name

Marlee Dorsey, MA, LPCC

Title

President

Phone

(612) 445-7781

Specialties & licenses 2

Addresses

Other names 1

• Reviving Roots Therapy & Wellness Doing business as

Locations

Practitioners 1

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

• Marlee James, LPCC

  • Mental Health Counselor
  • Minneapolis, MN
  • NPI 1386275311
  NPD

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

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600905600000",
    "number": "1548800915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3440 PORTLAND AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554074861",
            "telephone_number": "612-990-8172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3440 PORTLAND AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554074861",
            "telephone_number": "612-990-8172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE ROOTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-13",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A",
        "authorized_official_last_name": "DORSEY",
        "authorized_official_first_name": "MARLEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-445-7781",
        "authorized_official_credential": "MA, LPCC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reviving Roots Therapy & Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Reviving Roots Therapy & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peter John Reuter, CNP
• Revelation Assessments & Counseling Services
• Revitalize Health & Wellness, LLC
• Revive Care Services Inc.
• Revive Care Services Inc.
• Revive Wellness Center Inc
• Justin K Rewertz, LCSW
• Kirsten Clark Rewey, MSW, L.I.C.S.W.
• Kaitlyn Rextraw
• Jorge Luis Reyes Castro, MD

• Multi-Specialty Clinic/Center in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Multi-Specialty Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; 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.