Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 15227 | TX |
NPI | 1225595689 |
---|---|
Provider Name | Dr. Roslyn Phenix |
First Address | Arlington, TX 76006-4120 |
Second Address | Fort Worth, TX 76103-2435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2019 |
Last Update Date | 21/02/2019 |