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NPI Code Detail

MEDICARE: KATIE ROACH LPCC

MEDICARE: KATIE ROACH LPCC
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
1101YP2500XProfessional Counselor905-7-1-17-350ND
2101YP2500XProfessional CounselorSUP-LPCC-205ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215459011
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE ROACH LPCC
Provider Business Mailing Address
First Line : 2701 12TH AVE S
Second Line :
City : FARGO
State : ND
Zip : 58103-8753
Country : US
Telephone Number : 701-451-4900
Fax Number : 651-925-0057
Provider Business Practice Location Address
First Line : 2701 12TH AVE S
Second Line :
City : FARGO
State : ND
Zip : 58103-8753
Country : US
Telephone Number : 701-451-4900
Fax Number : 651-925-0057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2017
Last Update Date : 01/13/2026

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Directions to “ KATIE ROACH LPCC” Practice Location

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