Provider Demographics
NPI:1942380175
Name:DOSS, ROGER RON (PHD,LPC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:RON
Last Name:DOSS
Suffix:
Gender:M
Credentials:PHD,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 W PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-4504
Mailing Address - Country:US
Mailing Address - Phone:817-275-3617
Mailing Address - Fax:817-275-3620
Practice Address - Street 1:3617 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-4504
Practice Address - Country:US
Practice Address - Phone:817-275-3617
Practice Address - Fax:817-275-3620
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1129777-01Medicaid
TX1129777-02Medicaid