Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 22314 | TX |
N | 101YP1600X | Pastoral Counselor | TX | |
Y | 1041C0700X | Clinical Social Worker | 32614 | TX |
NPI | 1174767016 |
---|---|
Provider Name | Mr. Calvin Ray Roper |
First Address | Dallas, TX 75227-0022 |
Second Address | Dallas, TX 75227-1538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2009 |
Last Update Date | 15/10/2014 |