MEDICARE: DR. ROSLYN PHENIX PHD LCPC

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	101YP1600X	Pastoral Counselor	15227	TX

General Provider Information

NPI Number	:	1225595689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSLYN PHENIX PHD LCPC

Provider Business Mailing Address
First Line	:	2623 EASOM CIR APT 250
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-4120
Country	:	US
Telephone Number	:	832-754-4943
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 PURINGTON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-2435
Country	:	US
Telephone Number	:	682-235-4807
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2019
Last Update Date	:	02/21/2019

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