Johnathan Shane Roach

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P2507012 Issued in AR

Practice address

2607 Caddo St Ste 6
Arkadelphia, AR 71923-5307

Phone

(870) 230-8217

NPI assigned

Aug 3, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Arkansas Counseling and Psychodiagnostics, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Arkadelphia, AR
  • NPI 1902060684
  NPD
• Chenal Family Therapy, PLC

  • Mental Health Counselor
  • Little Rock, AR
  • NPI 1356604219
  NPD
• Arkansas Counseling and Psychodiagnostics, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Arkadelphia, AR
  • NPI 1356838569
  NPD (past)

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

{
    "created_epoch": "1659484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1124755715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10311 W MARKHAM ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722052135",
            "telephone_number": "870-340-2636",
            "fax_number": "888-816-7916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2607 CADDO ST STE 6",
            "city": "ARKADELPHIA",
            "state": "AR",
            "postal_code": "719235307",
            "telephone_number": "870-230-8217"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "321 E 13th St",
            "address_purpose": "LOCATION",
            "city": "Murfreesboro",
            "state": "AR",
            "postal_code": "719589541",
            "country_code": "US",
            "telephone_number": "870-285-3699",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROACH",
        "first_name": "JOHNATHAN",
        "middle_name": "SHANE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-03",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "91413",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P2507012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Richerson, M.S., L.A.C.
• Kimberly Rickett
• Yuliya Riddle
• Carri Lynn Riley
• Rivendell - Outreach Arkadelphia (UHS of Benton)
• Robert Anthony Dorman MD PA
• Jackie D Rollins, LMSW
• Ronald Scott Exum M.D. P.a.
• Ronald Scott Exum MD, PA (Arkadelphia Hospitalist)
• Amy Ross, MHPP

• Professional Counselor in Arkadelphia, AR
• Providers in Arkadelphia, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.