DR. JEREMY B ROARK PH.D.
NPI 1578860193
Psychologist in Ada, MI

Active since February 16, 2011
2650 SHUMAC LN SE, ADA, MI 49301(805) 570-7688 Get Directions Write a Review

NPPES record last updated: February 1, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Jeremy B Roark Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JEREMY B ROARK PH.D. (NPI 1578860193) is an individual psychologist in Ada, Michigan, licensed in California (PSY 24012) and active in the NPI registry since February 2011.

NPPES Registry Identity

NPI1578860193
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameDR. JEREMY B ROARKCredential: PH.D.
Location Address2650 SHUMAC LN SEAda, MI 49301-9355
Mailing Address2650 Shumac Ln SeAda, MI 49301-9355 · (805) 570-7688
Sole ProprietorYes
Enumeration DateFebruary 16, 2011
Last NPPES UpdateFebruary 1, 2024
NPPES CertifiedFebruary 1, 2024
NPI 1578860193 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in CA · PSY 24012
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
2650 SHUMAC LN SE, Ada, MI 49301

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jeremy Roark's NPI number?

The NPI number for Jeremy Roark is 1578860193. It was assigned to this individual provider in the NPPES registry on February 16, 2011.

Where is Jeremy Roark located?

Jeremy Roark practices at 2650 Shumac Ln SE, Ada, MI 49301. The listed phone number is (805) 570-7688.

What is Jeremy Roark's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

When was this NPI record last updated?

The NPPES record for Jeremy Roark was last updated on February 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.