Roxane Van Der Lelie, MFT-A

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

205075 Issued in TX

Practice address

1206 W 43Rd St
Austin, TX 78756-3302

Phone

(512) 710-7645

NPI assigned

Jan 29, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Group practices

Bloom Therapy PLLCGroup PAC ID 2365881455, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bloom Therapy, PLLC

  • Professional Counselor
  • Austin, TX
  • NPI 1649677006
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1851153498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 EASON ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787034822",
            "telephone_number": "631-943-6593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 W 43RD ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787563302",
            "telephone_number": "512-710-7645"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1205 W 43rd St",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787563301",
            "country_code": "US",
            "telephone_number": "512-710-7645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN DER LELIE",
        "first_name": "ROXANE",
        "credential": "MFT-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-29",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "205075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William C Van de Graaf, MD
• Grace Van de Hoef, SLP
• Jordan Michael Van de Vere, C. PED
• Annessa Faye Van de Walle, FNP
• Zachary David Van Den Berg, LPC-ASSOCIATE, ATR-P
• Christian J. Van Der Schijff, PT, DPT, LAT, ATC
• Tarina Van Der Stockt
• Catherine Van Der Westhuizen, MA, LPC, LMFT
• Heather Van Diest, MPH, LCSW
• Leah Van Duyne

• Marriage & Family Therapist in Austin, TX
• Providers in Austin, TX by specialty
• Marriage & Family Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.