Adrienne Therese Roth, PCC/LCDC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

E.1100044 Issued in OH

Practice address

624 Market Ave. N.
Canton, OH 44702-1017

Phone

(330) 493-4553

Fax

(330) 493-3761

NPI assigned

Aug 30, 2012

Sex

Female

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 OH

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

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Phoenix Rising Behavioral Healthcare and Recovery, Inc.Group PAC ID 2466485800, 30 clinicians

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 and National Provider Directory roles.

• Phoenix Rising Behavioral Healthcare and Recovery Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Canton, OH
  • NPI 1891737292
  Medicare reassignment Care Compare group NPD
• Phoenix Rising Behavioral Healthcare and Recovery, Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Canton, OH
  • NPI 1710238613
  NPD

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

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1790034114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 MARKET AVE. N",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021017",
            "telephone_number": "330-493-4553",
            "fax_number": "330-493-3761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 MARKET AVE. N.",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021017",
            "telephone_number": "330-493-4553",
            "fax_number": "330-493-3761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "ADRIENNE",
        "middle_name": "THERESE",
        "name_prefix": "Ms.",
        "credential": "PCC/LCDC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-30",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.1100044",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "702977",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miranda Ross, QMHS CMS
• Shannon Elizabeth Ross, RN
• Wendy Michelle Ross, RN
• Breana R Rossen, CT, CDCA
• Katelyn Roszkowski
• Mary Ellen Roth, O.D.
• Rachel A Roudebush, R.N.
• Stacey Roush
• Amanda Marie Rovnak, LISW, LICDC
• Dakota Rovnak, LSW

• Mental Health Counselor in Canton, OH
• Providers in Canton, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; 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.