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General NPI Number Information
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NPI Number | 1265086193
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Entity Type | Individual
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Provider Name | BRYE ROTH LPCC-S
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Gender | Female
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 1414 RIVERSIDE DR STE 200
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City | LAKEWOOD
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State | OH
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Zip | 44107-3319
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Country | US
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Telephone | 440-508-6765
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Fax |
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Provider Business Mailing Address
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Address Line | 1527 WINTON AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-3613
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Country | US
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Telephone | 440-454-3243
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.2202815
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.2202815-SUPV
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License Number State | OH
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