Active NPI
Justin Philip Roth
- Professional Counselor
- Huntington Woods, MI
National Provider Identifier
1376372292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6451017847
- Practice address
- 26711 Woodward Ave
Huntington Woods, MI 48070-1333 - Phone
- (312) 624-9815
- NPI assigned
- Jul 30, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6451017847 | MI | Primary |
Addresses
Primary practice location
26711 Woodward Ave
Huntington Woods, MI 48070-1333
Mailing address
209 Cloverport Ave
Rochester Hills, MI 48307-2714
Phone (248) 752-7574
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6451017847 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722297600000",
"number": "1376372292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 CLOVERPORT AVE",
"city": "ROCHESTER HILLS",
"state": "MI",
"postal_code": "483072714",
"telephone_number": "248-752-7574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26711 WOODWARD AVE",
"city": "HUNTINGTON WOODS",
"state": "MI",
"postal_code": "480701333",
"telephone_number": "312-624-9815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "JUSTIN",
"middle_name": "PHILIP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-07-30",
"last_updated": "2024-07-30",
"certification_date": "2024-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6451017847",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntington Woods, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.