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General NPI Number Information
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NPI Number | 1598300964
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH DEFENSE AND FITNESS, PLLC
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Dates
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Enumeration Date | 11/08/2019
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 6120 COLLEGE ST STE D185
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City | BEAUMONT
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State | TX
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Zip | 77707-3445
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Country | US
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Telephone | 409-550-1846
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Fax | 409-403-8432
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Provider Business Mailing Address
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Address Line | 6120 COLLEGE ST STE D185
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City | BEAUMONT
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State | TX
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Zip | 77707-3445
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Country | US
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Telephone | 409-550-1846
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Fax | 409-403-8432
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Authorized Official
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Title or Position | DIRECTOR
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Name | RORY CAROTHERS
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Credential | LPC
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Telephone | 409-550-1846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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