Rooted Well Therapy

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

ROOTED WELL THERAPY

Practice address

321 E Main St Ste 207
Bozeman, MT 59715-4731

Phone

(406) 209-4928

NPI assigned

Feb 15, 2024

Organization subpart

No

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

Authorized official

Name

Mackenzie Fulleton, LCSWNPI 1730831405

Title

Owner/Psychotherapist

Phone

(406) 209-4928

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mackenzie Fulleton, LCSW

  • Clinical Social Worker
  • Bozeman, MT
  • NPI 1730831405

  Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1707955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1699530097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10542 PO BOX",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "59719",
            "telephone_number": "406-209-4928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 E MAIN ST STE 207",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597154731",
            "telephone_number": "406-209-4928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOTED WELL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-15",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "FULLETON",
        "authorized_official_first_name": "MACKENZIE",
        "authorized_official_title_or_position": "OWNER/PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "406-209-4928",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Bozeman, MT
• Providers in Bozeman, 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 Oct 31, 2024; 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.