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General NPI Number Information
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NPI Number | 1225576143
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Entity Type | Organization
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Legal Business Name | ROSE HEART WELLNESS, PLLC
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Dates
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Enumeration Date | 02/11/2017
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 1103 HAZY HILLS LOOP
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City | DRIPPING SPRINGS
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State | TX
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Zip | 78620-2217
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Country | US
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Telephone | 214-783-5867
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Fax |
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Provider Business Mailing Address
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Address Line | 1103 HAZY HILLS LOOP
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City | DRIPPING SPRINGS
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State | TX
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Zip | 78620-2217
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | ANDREA GONZALEZ
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Credential | LCSW
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Telephone | 214-783-5867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 52548
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License Number State | TX
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