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General NPI Number Information
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NPI Number | 1003247677
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Entity Type | Individual
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Provider Name | JENNIFER ROACH MA, LCMHC
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Gender | Female
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 1076 W 1275 S
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City | SPRINGVILLE
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State | UT
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Zip | 84663-5060
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Country | US
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Telephone | 206-427-7754
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Fax | 425-258-5275
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Provider Business Mailing Address
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Address Line | 1076 W 1275 S
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City | SPRINGVILLE
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State | UT
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Zip | 84663-5060
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Country | US
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Telephone | 206-427-7754
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC-8331
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH61155476
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 12888612-6004
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License Number State | UT
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