Healthcare Provider Details

I. General information

NPI: 1790353019
Provider Name (Legal Business Name): KARLA ROTH COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 COMMERCE DR
HESSTON KS
67062-8938
US

IV. Provider business mailing address

114 COMMERCE DR
HESSTON KS
67062-8938
US

V. Phone/Fax

Practice location:
  • Phone: 620-869-9986
  • Fax:
Mailing address:
  • Phone: 620-869-9986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ADRIA ESTES
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 208-269-0689