Healthcare Provider Details

I. General information

NPI: 1942180450
Provider Name (Legal Business Name): DANGEL ROQUE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4522 SYLVANFIELD DR
HOUSTON TX
77014-1674
US

IV. Provider business mailing address

4522 SYLVANFIELD DR
HOUSTON TX
77014-1674
US

V. Phone/Fax

Practice location:
  • Phone: 346-768-7780
  • Fax:
Mailing address:
  • Phone: 346-554-5382
  • Fax: 346-554-5382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2103697578
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number1458428
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-460428
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number2103697578
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: