| Root & Return Therapy, A Licensed Clinical Social Worker Professional Corporation | |
|
3079 Harrison Ave 12 Unit 118 South Lake Tahoe CA 96150 | |
| (530) 447-0253 | |
| Not Available |
| Full Name | Root & Return Therapy, A Licensed Clinical Social Worker Professional Corporation |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3079 Harrison Ave 12, South Lake Tahoe, California |
| Authorized Official Name and Position | Ksenia Ustinova (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 5304470253 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Root & Return Therapy, A Licensed Clinical Social Worker Professional Corporation Po Box 9683 South Lake Tahoe CA 96158-2683 Ph: () - | Root & Return Therapy, A Licensed Clinical Social Worker Professional Corporation 3079 Harrison Ave 12 Unit 118 South Lake Tahoe CA 96150 Ph: (530) 447-0253 |
| NPI Number | 1821914995 |
|---|---|
| Provider Enumeration Date | 06/24/2026 |
| Last Update Date | 06/25/2026 |
| Certification Date | 06/25/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821914995 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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