Healthcare Provider Details

I. General information

NPI: 1114651288
Provider Name (Legal Business Name): ROSE QUARTZ THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W 10TH ST
LA JOYA TX
78560-9051
US

IV. Provider business mailing address

PO BOX 82
LA JOYA TX
78560-0082
US

V. Phone/Fax

Practice location:
  • Phone: 956-452-0168
  • Fax:
Mailing address:
  • Phone: 956-452-0168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ADRIANA NORETTE RUIZ
Title or Position: LPC ASSOCIATE
Credential: LPC ASSOCIATE
Phone: 956-862-0455