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General NPI Number Information
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NPI Number | 1851806640
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Entity Type | Individual
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Provider Name | MERDITH DALE ROACH JR. LPC
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Gender | Male
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Dates
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Enumeration Date | 12/03/2017
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Last Update Date | 12/03/2017
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Provider Practice Location Address
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Address Line | 12234 SHADOW CREEK PKWY STE 4104
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City | PEARLAND
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State | TX
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Zip | 77584-7333
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Country | US
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Telephone | 713-429-5325
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Fax |
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Provider Business Mailing Address
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Address Line | 8585 SIENNA SPRINGS BLVD APT 926
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City | MISSOURI CITY
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State | TX
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Zip | 77459-7205
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Country | US
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Telephone | 979-583-6627
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 74093
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License Number State | TX
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