NPIMap

Organization Active NPI

Roots Counseling Services, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Shorewood, WI
National Provider Identifier
1669889283
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
ROOTS COUNSELING SERVICES, LLC
Practice address
4485 N Oakland Ave
Shorewood, WI 53211-1611
Phone
(414) 273-8484
Fax
(414) 446-3317
NPI assigned
Jul 15, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Authorized official

Name
Trevor Nettles
Title
Administrator
Phone
(414) 273-8484

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

4485 N Oakland Ave
Shorewood, WI 53211-1611

Mailing address

4485 N Oakland Ave
Shorewood, WI 53211-1611
Phone (414) 273-8484

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D2168137Roots Counseling Services LLC4485 N Oakland Ave, Shorewood, WI 53211Certificate of waiverJun 20, 2027

National Provider Directory

National Provider Directory

Locations

1681 N Prospect Ave
Milwaukee, WI 53202
Phone (414) 273-8484

4485 N Oakland Ave
Shorewood, WI 53211
Phone (414) 273-8484

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1669889283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4485 N OAKLAND AVE",
            "city": "SHOREWOOD",
            "state": "WI",
            "postal_code": "532111611",
            "telephone_number": "414-273-8484",
            "fax_number": "414-446-3317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4485 N OAKLAND AVE",
            "city": "SHOREWOOD",
            "state": "WI",
            "postal_code": "532111611",
            "telephone_number": "414-273-8484",
            "fax_number": "414-446-3317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOTS COUNSELING SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-15",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "NETTLES",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "414-273-8484"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shorewood, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.