MEDICARE: LEA MICHELLE ROMAN 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	76916	TX

General Provider Information

NPI Number	:	1679117816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEA MICHELLE ROMAN LPC

Provider Business Mailing Address
First Line	:	612 LA SALLE DR
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-3510
Country	:	US
Telephone Number	:	214-789-9025
Fax Number	:

Provider Business Practice Location Address
First Line	:	8751 COLLIN MCKINNEY PKWY # 502
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-1656
Country	:	US
Telephone Number	:	214-618-0588
Fax Number	:

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

Provider Enumeration Date	:	10/31/2019
Last Update Date	:	10/31/2019

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