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General NPI Number Information
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NPI Number | 1710330980
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Entity Type | Individual
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Provider Name | MELODIE ROTH MS
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Gender | Female
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 12567 W CEDAR DR STE 250
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City | LAKEWOOD
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State | CO
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Zip | 80228-2039
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Country | US
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Telephone | 303-691-6095
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 W COUNTY ROAD 14 APT E2
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City | BERTHOUD
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State | CO
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Zip | 80513-8148
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Country | US
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Telephone | 720-951-8953
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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 | LPCC.0020621
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License Number State | CO
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