Individual
JENNIFER MICHELLE ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHCA
Contact information
Practice address
6544 FERGUSON ST, INDIANAPOLIS, IN 46220-1178
(317) 690-2941
Mailing address
6544 FERGUSON ST, INDIANAPOLIS, IN 46220-1178
(317) 690-2941
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
888000416A
IN
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
01/04/2017
Last updated
09/28/2017
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