DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: ROOSEVELT BROACH

MEDICARE: ROOSEVELT BROACH
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
1101YM0800XMental Health Counselor79180TX

General Provider Information

NPI Number : 1083280374
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROOSEVELT BROACH
Provider Business Mailing Address
First Line : 502 POINT ROYAL DR
Second Line :
City : ROCKWALL
State : TX
Zip : 75087-8721
Country : US
Telephone Number : 469-688-2803
Fax Number :
Provider Business Practice Location Address
First Line : 12959 JUPITER RD STE 140
Second Line :
City : DALLAS
State : TX
Zip : 75238-3200
Country : US
Telephone Number : 214-221-0132
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2021
Last Update Date : 05/27/2021

Similar Medicare Providers

1932195591 — MERCYGRACE HEALTHCARE, INC.
Practice Location Address:
12959 JUPITER ROAD , SUITE 140
DALLAS, TX
75238-3200
Practice Phone: 214-221-8585
Practice Fax: 214-221-8586
1902317050 — ZOOM HEALTH SERVICES INCORPORATION
Practice Location Address:
12959 JUPITER RD STE 140
DALLAS, TX
75238-3200
Practice Phone: 214-221-0132
Practice Fax: 214-221-0242
1376020958 — ALICIA BRIGHAM LPC
Practice Location Address:
12959 JUPITER RD STE 140
DALLAS, TX
75238-3200
Practice Phone: 817-879-2215
Practice Fax:
1669005187 — LAURA KAY MCDONALD
Practice Location Address:
12959 JUPITER RD STE 140
DALLAS, TX
75238-3200
Practice Phone: 214-221-0132
Practice Fax: 214-221-0242
1407476146 — ZOOM HOUSE CALL PROVIDERS
Practice Location Address:
12959 JUPITER RD STE 140
DALLAS, TX
75238-3200
Practice Phone: 817-405-9410
Practice Fax:
1215553680 — 2020 COUNSELING LLC
Practice Location Address:
12959 JUPITER RD STE 140
DALLAS, TX
75238-3200
Practice Phone: 817-903-0200
Practice Fax:

Directions to “ ROOSEVELT BROACH ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.