Charlene Jean Roth, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

35001635A Issued in IN

Practice address

5460 N 450 W
Shipshewana, IN 46565-8504

Phone

(260) 463-6915

Fax

(260) 499-4158

NPI assigned

Sep 3, 2008

Last updated

Sep 3, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Renew Hope Counseling Inc

  • Community/Behavioral Health Agency
  • Shipshewana, IN
  • NPI 1629216130
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220400000000",
    "number": "1083862072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 292",
            "city": "LAGRANGE",
            "state": "IN",
            "postal_code": "467610292",
            "telephone_number": "260-463-6915",
            "fax_number": "260-499-4158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5460 N 450 W",
            "city": "SHIPSHEWANA",
            "state": "IN",
            "postal_code": "465658504",
            "telephone_number": "260-463-6915",
            "fax_number": "260-499-4158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "CHARLENE",
        "middle_name": "JEAN",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-03",
        "last_updated": "2008-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IN",
            "license": "35001635A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mindful and Well
• Optometric Associates of South Bend (Insight Total Family Eyecare)
• Thomas Anthony Pechin II, M. D.
• Premise Health of Indiana Medical PC (Midway Lakepark - Shipshewana)
• Renew Hope Counseling Inc
• Harry Scott III, D.O.
• Rosemarie Ann Scottt, D.C.
• Hannah Ann Slate, M.D.
• Abigail Smith, MS
• Kiri Elyse Sunde, MD

• Marriage & Family Therapist in Shipshewana, IN
• Providers in Shipshewana, IN by specialty
• Marriage & Family Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.