Provider Demographics
NPI:1598300964
Name:MENTAL HEALTH DEFENSE AND FITNESS, PLLC
Entity Type:Organization
Organization Name:MENTAL HEALTH DEFENSE AND FITNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RORY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAROTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:409-790-2095
Mailing Address - Street 1:6945 KILLARNEY DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-4115
Mailing Address - Country:US
Mailing Address - Phone:409-812-5607
Mailing Address - Fax:409-403-8432
Practice Address - Street 1:2660 SWEETGUM LN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77703-4926
Practice Address - Country:US
Practice Address - Phone:409-812-5607
Practice Address - Fax:409-403-8432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)