MEDICARE: MS. BRENDA ALLEN ROLAND LPC

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	101YP2500X	Professional Counselor	62086	TX

General Provider Information

NPI Number	:	1215211990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRENDA ALLEN ROLAND LPC

Provider Business Mailing Address
First Line	:	5700 N BEACH ST
Second Line	:	1101
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-2824
Country	:	US
Telephone Number	:	940-634-3034
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 N BEACH ST
Second Line	:	1101
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-2824
Country	:	US
Telephone Number	:	940-634-3034
Fax Number	:

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

Provider Enumeration Date	:	09/29/2011
Last Update Date	:	09/29/2011

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