Healthcare Provider Details

I. General information

NPI: 1619115797
Provider Name (Legal Business Name): ROGER LANE POOLE M.A., M.ED., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 N MAIN ST STE C
CLEBURNE TX
76033-3803
US

IV. Provider business mailing address

212 BENT TREE TRL
BURLESON TX
76028-1234
US

V. Phone/Fax

Practice location:
  • Phone: 817-645-3328
  • Fax: 817-558-7566
Mailing address:
  • Phone: 817-995-3797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number64389
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number64389
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: