Provider Demographics
NPI:1962029298
Name:ROACH, KAMI (LPC)
Entity Type:Individual
Prefix:
First Name:KAMI
Middle Name:
Last Name:ROACH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KAMI
Other - Middle Name:
Other - Last Name:ELORRIETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:155 2ND AVE N STE 201
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6163
Mailing Address - Country:US
Mailing Address - Phone:208-751-0478
Mailing Address - Fax:
Practice Address - Street 1:155 2ND AVE N STE 201
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6163
Practice Address - Country:US
Practice Address - Phone:208-751-0478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7726101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor