Healthcare Provider Details

I. General information

NPI: 1922914951
Provider Name (Legal Business Name): ROEL CERVANTES LMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2606 PEDDLERS VILLAGE RD STE 210
GOSHEN IN
46526-1004
US

IV. Provider business mailing address

71691 COUNTY ROAD 33
SYRACUSE IN
46567-9248
US

V. Phone/Fax

Practice location:
  • Phone: 574-534-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88003419A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: