Provider Demographics
NPI:1689704835
Name:ROTH, LINDSAY (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:ROTH
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800114
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91380-0114
Mailing Address - Country:US
Mailing Address - Phone:661-964-7601
Mailing Address - Fax:
Practice Address - Street 1:25322 RYE CANYON RD
Practice Address - Street 2:SUITE #100-N
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1468
Practice Address - Country:US
Practice Address - Phone:661-964-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45324106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist