MEDICARE: REGENIA E ROACH 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1346868742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGENIA E ROACH LPC

Provider Business Mailing Address
First Line	:	4830 WILSON RD STE 300
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-1972
Country	:	US
Telephone Number	:	713-835-0259
Fax Number	:

Provider Business Practice Location Address
First Line	:	10327 ROCKAWAY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-3330
Country	:	US
Telephone Number	:	713-835-0259
Fax Number	:

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

Provider Enumeration Date	:	07/12/2020
Last Update Date	:	07/12/2020

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Directions to “ REGENIA E ROACH LPC” Practice Location

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