Provider Demographics
NPI:1043269087
Name:FORDON, ROXANNA LEE (LPC)
Entity Type:Individual
Prefix:
First Name:ROXANNA
Middle Name:LEE
Last Name:FORDON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 GREEN OAK PL
Mailing Address - Street 2:#208
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2057
Mailing Address - Country:US
Mailing Address - Phone:281-812-8489
Mailing Address - Fax:281-358-7788
Practice Address - Street 1:1521 GREEN OAK PL
Practice Address - Street 2:#208
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77339-2057
Practice Address - Country:US
Practice Address - Phone:281-812-8489
Practice Address - Fax:281-358-7788
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5314LCOtherBC/BS