Golden Roots Therapy, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

GOLDEN ROOTS THERAPY, LLC

Practice address

1614 Mahtomedi Ave
Mahtomedi, MN 55115-1909

Phone

(612) 662-3989

NPI assigned

Jun 27, 2024

Organization subpart

No

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

Authorized official

Name

Jenna Hertaus, LPCCNPI 1295349678

Title

Owner

Phone

(612) 662-3989

Specialties & licenses 3

Addresses

Other names 1

• Golden Roots Therapy Doing business as

Locations

Practitioners 2

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

• Jenna Hertaus, LPCC

  • Mental Health Counselor
  • Roseville, MN
  • NPI 1295349678
  NPD Authorized official
• Kaitlyn Matteson, MA, LADC

  • Counselor
  • Mahtomedi, MN
  • NPI 1699597351
  NPD

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

{
    "created_epoch": "1719446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1942045372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4707 HIGHWAY 61 N STE 61",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551103227",
            "telephone_number": "612-662-3989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 MAHTOMEDI AVE",
            "city": "MAHTOMEDI",
            "state": "MN",
            "postal_code": "551151909",
            "telephone_number": "612-662-3989"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12574 Foxhill Ave N",
            "address_purpose": "LOCATION",
            "city": "Hugo",
            "state": "MN",
            "postal_code": "550387544",
            "country_code": "US",
            "telephone_number": "612-662-3989",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GOLDEN ROOTS THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-27",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A",
        "authorized_official_last_name": "HERTAUS",
        "authorized_official_first_name": "JENNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-662-3989",
        "authorized_official_credential": "LPCC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Golden Roots Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrea Finch
• Virginia Fitch-Braun
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• Noel Fredericksen
• Lisa Giuliani, OTR/L
• Bradley John Hagen
• Steven Hagstrom, D.C.
• Katherine Hands
• Naomi Hemingway
• Steve Donald Herrick, LADC

• All providers in Mahtomedi, MN
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.