Individual provider Active NPI

Brandon J Roth, LPC

  • Professional Counselor
  • Fort Collins, CO
National Provider Identifier
1740925833
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC.0018181 Issued in CO
Practice address
306 Bowline CT
Fort Collins, CO 80525-3116
Phone
(208) 317-5875
NPI assigned
May 3, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC.0018181 CO Primary

Addresses

Primary practice location

306 Bowline CT
Fort Collins, CO 80525-3116

Mailing address

306 Bowline CT
Fort Collins, CO 80525-3116
Phone (208) 317-5875

Other practice location 1

4856 Innovation Dr
Fort Collins, CO 80525-5539
Phone (970) 494-4200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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

Enrollment IDStateProvider typePAC IDDetails
I20250205003875 CO Practitioner - Mental Health Counselor 1052841053 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LPC.0018181COMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Ba Counseling, Consultation and Education Professional CurrentSince Jan 21, 2024 Accepting new patients
Summitstone Health Partners Current Accepting new patients
Ba Counseling, Consultation and Education CurrentSince Mar 3, 2024 Accepting new patients
Summitstone Health Partners CurrentSince Feb 1, 2025 Accepting new patients
Summitstone Health Partners CurrentSince Feb 1, 2025 Accepting new patients
Longview Behavioral Health Past Accepting new patients
Summitstone Health Partners Past Accepting new patients
Longview Behavioral Health Professional Past Accepting new patients
Longview Behavioral Health Past Accepting new patients
Longview Behavioral Health Past Accepting new patients
Summitstone Health Partners Past Accepting new patients

Locations

4102 S Timberline Rd
Fort Collins, CO 80525
Phone (970) 494-5728

2627 Redwing Rd
Ste 325
Fort Collins, CO 80526
Phone (303) 435-3828

4856 Innovation Dr
Fort Collins, CO 80525

1250 N Wilson Ave
Loveland, CO 80537
Phone (970) 494-9789

8471 Turnpike Dr
Ste 220
Westminster, CO 80031
Phone (719) 588-1635

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1651536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742947200000",
    "number": "1740925833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 BOWLINE CT",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805253116",
            "telephone_number": "208-317-5875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 BOWLINE CT",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805253116",
            "telephone_number": "208-317-5875"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4856 Innovation Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805255539",
            "country_code": "US",
            "telephone_number": "970-494-4200",
            "fax_number": "844-270-1824",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROTH",
        "first_name": "BRANDON",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-03",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "LPC.0018181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.