Individual
CHARLENE JEAN ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
5460 N 450 W, SHIPSHEWANA, IN 46565-8504
(260) 463-6915
(260) 499-4158
Mailing address
PO BOX 292, LAGRANGE, IN 46761-0292
(260) 463-6915
(260) 499-4158
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
35001635A
IN
Other
Enumeration date
09/03/2008
Last updated
09/03/2008
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