Provider Demographics
NPI:1457400582
Name:ROOS, PHILIP (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:ROOS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 TIFFANY PARK CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2037
Mailing Address - Country:US
Mailing Address - Phone:817-446-6966
Mailing Address - Fax:817-446-7520
Practice Address - Street 1:4025 WOODLAND PARK BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013
Practice Address - Country:US
Practice Address - Phone:817-461-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX470101YA0400X
TX853106H00000X
TX20408103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00FJ596OtherBLUE CROSS BLUE SHIELD
TX00FJ596Medicare ID - Type Unspecified