Doctor Name: | MR. JIM BYRON ROATEN |
NPI Number: | 1861521494 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MED LPC |
License Number: | 2996 |
Business Practice Address: | 5608 Malvey Ave Ste 306 Ft Worth, TX - 761075162 |
Business Phone Number: | 8177373989 |
Business Fax Number: | 8177375757 |
Mailing Address: | 5608 Malvey Ave Ste 306, FT WORTH |
State: | TX |
Postal Code: | 761075162 |
Phone Number: | 8177373989 |
Fax Number: | 8177375757 |
NPI Enumeration Date: | 03/02/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 2996 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |