Provider Demographics
NPI:1417696253
Name:ROTHS MHA LLC
Entity Type:Organization
Organization Name:ROTHS MHA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROTHS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCMH, QMHP
Authorized Official - Phone:605-359-9448
Mailing Address - Street 1:4208 S ASH GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4910
Mailing Address - Country:US
Mailing Address - Phone:605-359-9448
Mailing Address - Fax:
Practice Address - Street 1:5024 S BUR OAK PL STE 212
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2238
Practice Address - Country:US
Practice Address - Phone:605-359-9448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty