DR. KENNETH DAVID ROACH LCMHC
NPI 1619189628
Counselor - Professional in Salt Lake City, UT
About Dr. Kenneth David Roach Lcmhc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. KENNETH DAVID ROACH LCMHC (NPI 1619189628) is an individual professional provider in Salt Lake City, Utah, licensed in Utah (4909154-6004) and active in the NPI registry since May 2007. He is enrolled in Medicare PECOS and maintains a secondary practice location in Pleasant Grove.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Kenneth David Roach Lcmhc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kenneth Roach reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Holladay, UT 84117
- Reassigned Medicare billing, Utah enrollment
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SALT LAKE CITY, UT 84124
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 Kenneth Roach's NPI number?
The NPI number for Kenneth Roach is 1619189628. It was assigned to this individual provider in the NPPES registry on May 3, 2007.
Where is Kenneth Roach located?
Kenneth Roach practices at 4190 S Highland Dr Ste 210, Salt Lake City, UT 84124. The listed phone number is (801) 792-7028.
What is Kenneth Roach's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.
Is Kenneth Roach enrolled in Medicare?
Yes. Kenneth Roach is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kenneth Roach's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kenneth Roach reassigns Medicare benefits to Mount Olympus Counseling Center, Inc. (Holladay, UT). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kenneth Roach's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kenneth Roach accept?
Health plans from BridgeSpan Health Company, Regence BlueCross BlueShield of Utah and Select Health list Kenneth Roach as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Kenneth Roach was last updated on October 10, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.
# Dr. Kenneth David Roach, LCMHC · NPI 1619189628
Professional provider in Salt Lake City, Utah. Individual provider, active in the CMS NPPES registry since May 3, 2007.
## Identity
- **NPI:** 1619189628 (Entity type: Individual)
- **Enumerated:** May 3, 2007
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** 4909154-6004 (Utah)
- **Sole proprietor:** No
## Practice location
- **Address:** 4190 S HIGHLAND DR STE 210, Salt Lake City, UT 84124-2674
- **Phone:** (801) 792-7028
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Mount Olympus Counseling Center, Inc. (NPI 1053910331, Holladay, UT), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 10, 2018
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Source: [NPI Profile](https://npiprofile.com/npi/1619189628) · Data from the CMS NPPES public registry.