Provider Demographics
NPI:1447425616
Name:ROTH, TERI BETH (LPC)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:BETH
Last Name:ROTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1374 S PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2229
Mailing Address - Country:US
Mailing Address - Phone:303-778-8171
Mailing Address - Fax:303-778-8171
Practice Address - Street 1:1374 S PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2229
Practice Address - Country:US
Practice Address - Phone:303-778-8171
Practice Address - Fax:303-778-8171
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1945101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional