Provider Demographics
NPI:1265086193
Name:ROTH, BRYE (LPCC-S)
Entity type:Individual
Prefix:
First Name:BRYE
Middle Name:
Last Name:ROTH
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 WINTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3613
Mailing Address - Country:US
Mailing Address - Phone:440-454-3243
Mailing Address - Fax:
Practice Address - Street 1:1414 RIVERSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3319
Practice Address - Country:US
Practice Address - Phone:440-508-6765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2202815101YP2500X
OHE.2202815-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional