Kenneth David Roach, LCMHC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4909154-6004 Issued in UT

Practice address

4190 S Highland Dr Ste 210
Salt Lake City, UT 84124-2674

Phone

(801) 792-7028

NPI assigned

May 3, 2007

Last updated

Oct 10, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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.

Enrollment records 1

Specialty

Mental Health Counselor

Education

University of Utah School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mount Olympus Counseling Center, Inc.

  • Mental Health Counselor
  • Holladay, UT
  • NPI 1053910331
  Medicare reassignment NPD Authorized official
• Midtown Counseling

  • Professional Counselor
  • Salt Lake City, UT
  • NPI 1033684618

  Mental Health

  NPD (past) Authorized official

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539129600000",
    "number": "1619189628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1131 LOCH LOMOND WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841174974",
            "telephone_number": "801-281-1078",
            "fax_number": "801-269-7565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 S HIGHLAND DR STE 210",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841242674",
            "telephone_number": "801-792-7028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "451 E 1000 S Ste B",
            "address_purpose": "LOCATION",
            "city": "Pleasant Grove",
            "state": "UT",
            "postal_code": "840623735",
            "country_code": "US",
            "telephone_number": "801-792-7028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROACH",
        "first_name": "KENNETH",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "LCMHC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2018-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "4909154-6004",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "UT",
            "license": "4909154-6004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• RM Med Ut, LLC (Rocky Mountain Medical Clinic)
• RMC Counseling
• Rmce Sarah Daft Home Alf Oc LLC (Sarah Daft Home)
• Benjamin B Roa, PHD
• Ashley Traczewitz Roach, D.M.D.
• Megan K Roach
• Tiffany Roach
• Jason Thomas Daniel Robb
• Heather Lyn Robbins
• Krista Robbins, PHD

• Professional Counselor in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Professional Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.