Provider Demographics
NPI:1861521494
Name:ROATEN, JAMES BYRON (MED LPC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BYRON
Last Name:ROATEN
Suffix:
Gender:M
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 MALVEY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5107
Mailing Address - Country:US
Mailing Address - Phone:817-737-5599
Mailing Address - Fax:817-737-5757
Practice Address - Street 1:5608 MALVEY AVE STE 101
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5107
Practice Address - Country:US
Practice Address - Phone:817-737-5599
Practice Address - Fax:817-737-5757
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2996101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2996OtherLPC