DEEPLY ROOTED FAMILY COUNSELING PROF CORP
NPI 1104697499
Counselor - Mental Health in Fresno, CA
About Deeply Rooted Family Counseling Prof Corp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DEEPLY ROOTED FAMILY COUNSELING PROF CORP (NPI 1104697499), doing business as Deeply Rooted Family Counseling, is a healthcare organization registered as a mental health in Fresno, California and active in the NPI registry since January 2024. The organization maintains a secondary practice location in Fresno and lists Jackson Spencer, President/clinician, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Secondary Practice Location 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Deeply Rooted Family Counseling Prof Corp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Deeply Rooted Family Counseling Prof Corp, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Deeply Rooted Family Counseling Prof Corp's NPI number?
The NPI number for Deeply Rooted Family Counseling Prof Corp is 1104697499. It was assigned to this organization in the NPPES registry on January 15, 2024. The provider is doing business as Deeply Rooted Family Counseling.
Where is Deeply Rooted Family Counseling Prof Corp located?
Deeply Rooted Family Counseling Prof Corp is located at 5740 N Palm Ave Ste 101, Fresno, CA 93704. The listed phone number is (559) 283-5441.
What is Deeply Rooted Family Counseling Prof Corp's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Deeply Rooted Family Counseling Prof Corp enrolled in Medicare?
Yes. Deeply Rooted Family Counseling Prof Corp is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Deeply Rooted Family Counseling Prof Corp?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Marriage and Family Therapist) reassigns their Medicare billing to Deeply Rooted Family Counseling Prof Corp. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Deeply Rooted Family Counseling Prof Corp was last updated on June 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Deeply Rooted Family Counseling Prof Corp · NPI 1104697499
Mental Health organization in Fresno, California. Organization record, active in the CMS NPPES registry since January 15, 2024.
## Identity
- **NPI:** 1104697499 (Entity type: Organization)
- **Enumerated:** January 15, 2024
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **Also known as:** Deeply Rooted Family Counseling (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Jackson Spencer, PRESIDENT/CLINICIAN
## Practice location
- **Address:** 5740 N PALM AVE STE 101, Fresno, CA 93704-1800
- **Phone:** (559) 283-5441
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Marriage and Family Therapist) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 25, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1104697499) · Data from the CMS NPPES public registry.