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NPI Code Detail

MEDICARE: MR. MARC ROTH LMHC

MEDICARE: MR. MARC ROTH LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor39001276AIN

General Provider Information

NPI Number : 1184613028
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARC ROTH LMHC
Provider Business Mailing Address
First Line : 1908 W LINCOLN AVE
Second Line :
City : GOSHEN
State : IN
Zip : 46526-5907
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1930 W LINCOLN AVE
Second Line :
City : GOSHEN
State : IN
Zip : 46526-5907
Country : US
Telephone Number : 574-534-2161
Fax Number : 574-534-3887
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 12/18/2012

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Directions to “ MR. MARC ROTH LMHC” Practice Location

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