Provider Demographics
NPI:1881410454
Name:ROACH, RILEY ASPEN
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:ASPEN
Last Name:ROACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2201
Mailing Address - Country:US
Mailing Address - Phone:530-355-8437
Mailing Address - Fax:
Practice Address - Street 1:2400 WASHINGTON AVE STE 400
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2827
Practice Address - Country:US
Practice Address - Phone:530-941-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-28
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT151340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health