Provider Demographics
NPI:1225595689
Name:PHENIX, ROSLYN (PHD LCPC)
Entity Type:Individual
Prefix:DR
First Name:ROSLYN
Middle Name:
Last Name:PHENIX
Suffix:
Gender:F
Credentials:PHD LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 EASOM CIR APT 250
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-4120
Mailing Address - Country:US
Mailing Address - Phone:832-754-4943
Mailing Address - Fax:
Practice Address - Street 1:3201 PURINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-2435
Practice Address - Country:US
Practice Address - Phone:682-235-4807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15227101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral