Provider Demographics
NPI:1023027000
Name:ROSE, PATRICIA RIDDLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:RIDDLE
Last Name:ROSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5944 LUTHER LN
Mailing Address - Street 2:SUITE 650
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5942
Mailing Address - Country:US
Mailing Address - Phone:214-373-4467
Mailing Address - Fax:214-373-6360
Practice Address - Street 1:5944 LUTHER LN
Practice Address - Street 2:SUITE 650
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5942
Practice Address - Country:US
Practice Address - Phone:214-373-4467
Practice Address - Fax:214-373-6360
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD90RMedicare ID - Type Unspecified