ROOSEVELT BROACH NPI 1083280374

NPI Information

NPI: 1083280374
Provider Name: ROOSEVELT BROACH
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

Address:
12959 JUPITER RD STE 140
DALLAS, TX
ZIP 75238
Phone: (214) 221-0132
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Roosevelt Broach is a mental health counselor in Dallas, TX. Roosevelt Broach NPI is 1083280374. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

12959 JUPITER RD STE 140
DALLAS, TX
ZIP 75238-200
Phone: (214) 221-0132

The enumeration date for this NPI number is 5/27/2021 and was last updated on 5/27/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health	79180	TEXAS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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