Gary Dean Roth, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

6401007486 Issued in MI

Practice address

4151 Shrestha Dr
Bay City, MI 48706-2171

Phone

(989) 203-0602

Fax

(989) 684-4331

NPI assigned

Nov 24, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: listpsychologicalservices.garyroth@130916.advancedmd-direct.com

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.

• Maple Leaf Counseling Services LLC

  • Social Worker
  • Saginaw, MI
  • NPI 1992295281

  Counselor

  NPD

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

{
    "created_epoch": "1259020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1467780841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4151 SHRESTHA DR STE D",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487062171",
            "telephone_number": "989-220-3060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4151 SHRESTHA DR",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487062171",
            "telephone_number": "989-203-0602",
            "fax_number": "989-684-4331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "GARY",
        "middle_name": "DEAN",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-24",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401007486",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "7509139660",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wendy Rose, NP
• Gregory Arthur Rosecrans, DDS
• Bridget Ross
• Melinda Ross
• Shannen Leigh Ross
• Phillip Roth
• Rylyn Roth, DDS
• Gina Roughton, M.S., CCC-SLP
• Paul Warren Rowe, MD
• Hunter Roy

• Counselor in Bay City, MI
• Providers in Bay City, MI by specialty
• Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; 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.