Healthcare Provider Details

I. General information

NPI: 1912168337
Provider Name (Legal Business Name): ROSE OBAZE LPC, LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N CEDAR RIDGE DR STE 227
DUNCANVILLE TX
75116-3169
US

IV. Provider business mailing address

435 CANDLELIGHT AVE
DUNCANVILLE TX
75137-3314
US

V. Phone/Fax

Practice location:
  • Phone: 214-460-4285
  • Fax: 972-709-1848
Mailing address:
  • Phone: 214-460-4285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4220
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13926
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: