Individual
DR. KENNETH DAVID ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCMHC
Contact information
Practice address
4190 S HIGHLAND DR STE 210, SALT LAKE CITY, UT 84124-2674
(801) 792-7028
Mailing address
1131 LOCH LOMOND WAY, SALT LAKE CITY, UT 84117-4974
(801) 281-1078
(801) 269-7565
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
4909154-6004
UT
101YP2500X
Professional Counselor
Primary
4909154-6004
UT
Other
Enumeration date
05/03/2007
Last updated
10/10/2018
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