Organization
MIDTOWN COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH DAVID ROACH LCMHC (OWNER)
(801) 860-7818
Entity
Organization
Contact information
Practice address
4190 S HIGHLAND DR STE 210, SALT LAKE CITY, UT 84124-2674
(801) 792-7028
Mailing address
1131 E LOCH LOMOND WAY, SALT LAKE CITY, UT 84117-4974
(801) 860-7818
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
10/10/2018
Last updated
10/10/2018
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