Deeply Rooted Family Counseling Prof Corp
NPI 1104697499ActiveOrganization· Counselor, Mental Health· Fresno, CA
Counselor, Mental Health in Fresno, California, registered in NPPES in January 2024. The authorized official on file is Jackson Spencer, LMFT, President/Clinician. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1104697499 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 15, 2024 |
| Last updated in NPPES | Jun 25, 2026 |
| Certified by provider | Jun 25, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Counselor, Mental Health Primary | 101YM0800X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (CA) |
|---|
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