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General NPI Number Information
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NPI Number | 1063637221
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Entity Type | Individual
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Provider Name | ANN I ROOSE PHD
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Gender | Female
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Dates
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Enumeration Date | 04/14/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 7424 GREENVILLE AVE STE 104
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City | DALLAS
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State | TX
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Zip | 75231-4552
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Country | US
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Telephone | 214-536-2745
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Fax | 877-282-8166
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Provider Business Mailing Address
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Address Line | 2309 CHINABERRY DR
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City | BEDFORD
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State | TX
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Zip | 76021-5209
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Country | US
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Telephone | 214-536-2745
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Fax | 877-282-8166
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 23644
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License Number State | TX
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