Provider Demographics
NPI:1538295696
Name:ROY, DORYN ADEL (MA)
Entity Type:Individual
Prefix:MRS
First Name:DORYN
Middle Name:ADEL
Last Name:ROY
Suffix:
Gender:F
Credentials:MA
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 330051
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76163-0051
Mailing Address - Country:US
Mailing Address - Phone:817-694-0528
Mailing Address - Fax:
Practice Address - Street 1:4701 ALTAMESA BLVD
Practice Address - Street 2:2B
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-6112
Practice Address - Country:US
Practice Address - Phone:817-964-0528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2011-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX68015OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS