Eric Vaughn Rothe, LPC

Individual provider Active NPI Professional Counselor · Jacksboro, TX

NPI 1962022632 · NPPES record last updated Apr 22, 2020

Key facts

NPI
1962022632
Entity type
Individual (NPI type 1)
Primary specialty
Professional Counselor 101YP2500X
License
77147 (TX)
Practice address
115 E Archer St
Jacksboro, TX 76458-1801
Phone
(214) 232-5568
NPI assigned
Apr 22, 2020
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
77147TXMDProfessional Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor
Group: 193400000X SINGLE SPECIALTY GROUP
101YP2500X 77147 TX Yes

Addresses

Primary practice location

115 E Archer St
Jacksboro, TX 76458-1801

Mailing address

PO Box 1053
Jacksboro, TX 76458-7053
Phone (214) 232-5568

Other providers in Jacksboro, TX

All providers in Jacksboro, TX · Professional Counselor in Texas

Sources for this page

Verify at the official NPI Registry.