Healthcare Provider Details

I. General information

NPI: 1205932662
Provider Name (Legal Business Name): GILBERT JOSEPH ROTH D.MIN.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HAZEL PATH SUITE3
HENDERSONVILLE TN
37075
US

IV. Provider business mailing address

156 WEST HARBOR
HENDERSONVILLE TN
37075
US

V. Phone/Fax

Practice location:
  • Phone: 615-822-1116
  • Fax:
Mailing address:
  • Phone: 615-264-0073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number79330
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1541
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number32
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number565
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: