1699929968 NPI number — GRETTA M ROTH M. COUN., L.P.C

NPI Number: 1699929968
Health Care Provider/Practitioner: GRETTA M ROTH M. COUN., L.P.C

NPI Number : 1699929968 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1699929968",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROTH",
    "FirstName": "GRETTA",
    "MiddleName": "M",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "M. COUN., L.P.C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "41 RENEGADE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RIVERTON",
    "MailingAddressStateName": "WY",
    "MailingAddressPostalCode": "82501-9214",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "307-709-1777",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "41 RENEGADE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RIVERTON",
    "PracticeLocationAddressStateName": "WY",
    "PracticeLocationAddressPostalCode": "82501-9214",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "307-709-1777",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/12/2008",
    "LastUpdateDate": "07/22/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "4088",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YS0200X",
          "TaxonomyName": "School Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "1849",
          "LicenseNumberStateCode": "WY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}