Provider Demographics
NPI:1508878026
Name:ROCHE, JOHN ALLEN (LMHC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLEN
Last Name:ROCHE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W VENTRIS AVE
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5559
Mailing Address - Country:US
Mailing Address - Phone:407-782-1639
Mailing Address - Fax:
Practice Address - Street 1:108 ROBIN RD
Practice Address - Street 2:SUITE 1006
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5035
Practice Address - Country:US
Practice Address - Phone:407-782-1639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7151101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health