MEDICARE: DR. PHILIP ROOS PH.D.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	470	TX
2	106H00000X	Marriage & Family Therapist	853	TX
3	103T00000X	Psychologist	20408	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00FJ596	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1457400582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP ROOS PH.D.

Provider Business Mailing Address
First Line	:	6100 TIFFANY PARK CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-2037
Country	:	US
Telephone Number	:	817-446-6966
Fax Number	:	817-446-7520

Provider Business Practice Location Address
First Line	:	4025 WOODLAND PARK BLVD
Second Line	:	SUITE 290
City	:	ARLINGTON
State	:	TX
Zip	:	76013
Country	:	US
Telephone Number	:	817-461-0200
Fax Number	:

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	04/12/2026

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