Provider Demographics
NPI:1053157172
Name:INSIGHTFUL ROOTS FAMILY THERAPY INC
Entity type:Organization
Organization Name:INSIGHTFUL ROOTS FAMILY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:RONQUILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-451-8623
Mailing Address - Street 1:455 UNIVERSITY AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:455 UNIVERSITY AVE STE 215
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6580
Practice Address - Country:US
Practice Address - Phone:916-209-0348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty