MEDICARE: SPENCER J ROESCH 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
1	101YP2500X	Professional Counselor	19861	CA

General Provider Information

NPI Number	:	1457234411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER J ROESCH LPCC

Provider Business Mailing Address
First Line	:	PO BOX 205
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91102-0205
Country	:	US
Telephone Number	:	740-816-9509
Fax Number	:

Provider Business Practice Location Address
First Line	:	261 N MADISON AVE APT 109
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-4474
Country	:	US
Telephone Number	:	740-816-9509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	07/28/2025

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