Provider Demographics
NPI:1881974020
Name:ROTH, JAMES JOSEPH (MED, LPC, LISAC,)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOSEPH
Last Name:ROTH
Suffix:
Gender:M
Credentials:MED, LPC, LISAC,
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 10701
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85271-0701
Mailing Address - Country:US
Mailing Address - Phone:480-966-3991
Mailing Address - Fax:480-966-4032
Practice Address - Street 1:16260 N 71ST ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4900
Practice Address - Country:US
Practice Address - Phone:480-966-3991
Practice Address - Fax:480-966-4032
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-0769101YA0400X
AZLPC-2419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ12078741OtherCAQH