Rooted Therapy and Wellness, PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

ROOTED THERAPY AND WELLNESS, PLLC

Practice address

3546 E Greystone Dr
Fayetteville, AR 72764-6860

Phone

(509) 434-6386

NPI assigned

Oct 29, 2024

Organization subpart

No

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

Authorized official

Name

Michelle Wise Gendusa, LCSW, LICSWNPI 1598505513

Title

Owner/Therapist

Phone

(509) 434-6386

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Practitioners 1

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

• Michelle Wise Gendusa, LICSW

  • Clinical Social Worker
  • Fayetteville, AR
  • NPI 1598505513
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1730160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1811719040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3546 E GREYSTONE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727646860",
            "telephone_number": "509-434-6386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3546 E GREYSTONE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727646860",
            "telephone_number": "509-434-6386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOTED THERAPY AND WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-29",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "WISE GENDUSA",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "509-434-6386",
        "authorized_official_credential": "LCSW, LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Mackenzie Romo, PHARMD
• Root & Rise, LLC
• Rooted Counseling & Consulting, LLC
• Rooted Family Care PLLC
• Rooted Hope Counseling and Consulting PLC
• Ros Family Medicine LLC
• Ananda Engber Rosa, LCSW
• Johanna Rosa
• Abigail Emily Rose, MHPP
• Devin Rose, PHARMD

• Clinical Social Worker in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; 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.