Provider Demographics
NPI:1215211990
Name:ROLAND, BRENDA ALLEN (LPC)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:ALLEN
Last Name:ROLAND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 N BEACH ST
Mailing Address - Street 2:1101
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76137-2824
Mailing Address - Country:US
Mailing Address - Phone:940-634-3034
Mailing Address - Fax:
Practice Address - Street 1:5700 N BEACH ST
Practice Address - Street 2:1101
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76137-2824
Practice Address - Country:US
Practice Address - Phone:940-634-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional