Individual
MR. MARC ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
1930 W LINCOLN AVE, GOSHEN, IN 46526-5907
(574) 534-2161
(574) 534-3887
Mailing address
1908 W LINCOLN AVE, GOSHEN, IN 46526-5907
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39001276A
IN
Other
Enumeration date
10/13/2005
Last updated
12/18/2012
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