Active NPI
Robert Scott Roderick, LPC
- Professional Counselor
- Cottonwood, AZ
National Provider Identifier
1528009651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-10659
- Practice address
- 1756 E Villa Dr Ste C1
Cottonwood, AZ 86326-4741 - Phone
- (928) 613-2093
- Fax
- (844) 224-2893
- NPI assigned
- Jun 9, 2006
- 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 | LPC-10659 | AZ | Primary |
Addresses
Primary practice location
1756 E Villa Dr Ste C1
Cottonwood, AZ 86326-4741
Mailing address
1756 E Villa Dr Ste C1
Cottonwood, AZ 86326-4741
Phone (928) 613-2093
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 |
|---|---|---|---|
| LPC-10659 | AZ | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sage Counseling, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Scottsdale, AZ
- NPI 1114501921
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595376000000",
"number": "1528009651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1756 E VILLA DR STE C1",
"city": "COTTONWOOD",
"state": "AZ",
"postal_code": "863264741",
"telephone_number": "928-613-2093",
"fax_number": "844-224-2893"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1756 E VILLA DR STE C1",
"city": "COTTONWOOD",
"state": "AZ",
"postal_code": "863264741",
"telephone_number": "928-613-2093",
"fax_number": "844-224-2893"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODERICK",
"first_name": "ROBERT",
"middle_name": "SCOTT",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-09",
"last_updated": "2020-07-22",
"certification_date": "2020-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AZ",
"license": "LPC-10659",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cottonwood, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.