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NPI Code Detail

MEDICARE: MR. ROGER LANE POOLE M.A., M.ED., LPC

MEDICARE: MR. ROGER LANE POOLE M.A., M.ED., 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
1101YS0200XSchool Counselor64389TX
2101YM0800XMental Health Counselor64389TX

General Provider Information

NPI Number : 1619115797
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROGER LANE POOLE M.A., M.ED., LPC
Provider Business Mailing Address
First Line : 212 BENT TREE TRL
Second Line :
City : BURLESON
State : TX
Zip : 76028-1234
Country : US
Telephone Number : 817-995-3797
Fax Number :
Provider Business Practice Location Address
First Line : 904 N MAIN ST STE C
Second Line :
City : CLEBURNE
State : TX
Zip : 76033-3803
Country : US
Telephone Number : 817-645-3328
Fax Number : 817-558-7566
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2009
Last Update Date : 12/09/2025

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