Provider Demographics
NPI:1194036707
Name:BHATT, ROMA SAMIR (LPC)
Entity Type:Individual
Prefix:MISS
First Name:ROMA
Middle Name:SAMIR
Last Name:BHATT
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:PO BOX 66308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-6308
Mailing Address - Country:US
Mailing Address - Phone:832-548-5000
Mailing Address - Fax:713-523-4897
Practice Address - Street 1:6500 ROOKIN SUITE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5014
Practice Address - Country:US
Practice Address - Phone:832-548-5000
Practice Address - Fax:713-523-4897
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64595101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080462703Medicaid
TX671836Medicare Oscar/Certification