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1083280374
ROOSEVELT BROACH
DALLAS, TX
NPI
1083280374
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: TX 79180)
Enumeration Date
2021-05-27
Last Update Date
2021-05-27
Business Address
ROOSEVELT BROACH
12959 JUPITER RD STE 140
DALLAS, TX 75238-3200
Phone number: 214-221-0132
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Mailing Address
ROOSEVELT BROACH
502 POINT ROYAL DR
ROCKWALL, TX 75087-8721
Phone number: 469-688-2803
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