MEDICARE: STEADFAST HEALTH & WELLNESS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003588856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEADFAST HEALTH & WELLNESS PLLC

Provider Business Mailing Address
First Line	:	1219 DALLAS ST
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-2908
Country	:	US
Telephone Number	:	409-234-5777
Fax Number	:	877-250-4835

Provider Business Practice Location Address
First Line	:	1219 DALLAS ST
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-2908
Country	:	US
Telephone Number	:	409-234-5777
Fax Number	:	877-250-4835

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BRANDON MICHAEL ROBERTS
Credential	:	M.ED., NCC, LPC
Telephone Number	:	409-790-8318

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	04/13/2022

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