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General NPI Number Information
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NPI Number | 1760481709
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Entity Type | Organization
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Legal Business Name | ROSE STREET MENTAL HEALTH CARE, LLP
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1808 ROSE ST
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City | WICHITA FALLS
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State | TX
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Zip | 76301-4219
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Country | US
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Telephone | 940-723-4488
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Fax | 940-723-0446
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Provider Business Mailing Address
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Address Line | 1808 ROSE ST
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City | WICHITA FALLS
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State | TX
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Zip | 76301-4219
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Country | US
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Telephone | 940-723-4488
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Fax | 940-723-0446
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHANNON WINTER
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Credential |
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Telephone | 940-322-9456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | TX
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