Provider Demographics
NPI:1780068262
Name:MYPATHCOUNSELING, PLLC
Entity type:Organization
Organization Name:MYPATHCOUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEHRBORN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP, LCDC, LPC, LMFT
Authorized Official - Phone:214-945-2599
Mailing Address - Street 1:5924 ROYAL LN
Mailing Address - Street 2:SUITE 265
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3863
Mailing Address - Country:US
Mailing Address - Phone:214-945-2599
Mailing Address - Fax:
Practice Address - Street 1:5924 ROYAL LN
Practice Address - Street 2:SUITE 265
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-3863
Practice Address - Country:US
Practice Address - Phone:214-945-2599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11829101YA0400X
TX201916106H00000X
TX69479101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty