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General NPI Number Information
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NPI Number | 1326411752
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Entity Type | Organization
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Legal Business Name | COLLEEN ROOSE
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Dates
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Enumeration Date | 11/06/2015
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Last Update Date | 11/06/2015
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Provider Practice Location Address
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Address Line | 14811 SAINT MARYS LN STE 288
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City | HOUSTON
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State | TX
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Zip | 77079-2916
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Country | US
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Telephone | 713-714-7453
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Fax |
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Provider Business Mailing Address
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Address Line | 9127 COVENT GARDEN ST
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City | HOUSTON
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State | TX
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Zip | 77031-3017
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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 | LCSW
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Name | COLLEEN ROOS
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Credential | LCSW
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Telephone | 570-574-0616
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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 | 54496
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License Number State | TX
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