MEDICARE: KENDRICA DESHAWN ROBERTS LCDC, 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
2	101YP2500X	Professional Counselor	95178	TX
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	17027	TX

General Provider Information

NPI Number	:	1538948013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRICA DESHAWN ROBERTS LCDC, LPC

Provider Business Mailing Address
First Line	:	2408 SAGAMORE ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-1079
Country	:	US
Telephone Number	:	918-813-8299
Fax Number	:

Provider Business Practice Location Address
First Line	:	2408 SAGAMORE ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-1079
Country	:	US
Telephone Number	:	940-255-7665
Fax Number	:	682-334-7365

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

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	02/18/2026

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