Provider Demographics
NPI:1063639680
Name:SCHMIDT, ROSA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8656 W HIGHWAY 71 BLDG A
Mailing Address - Street 2:STE C
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8075
Mailing Address - Country:US
Mailing Address - Phone:512-854-2176
Mailing Address - Fax:512-854-2182
Practice Address - Street 1:8656 W HIGHWAY 71 BLDG A
Practice Address - Street 2:STE C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8075
Practice Address - Country:US
Practice Address - Phone:512-854-2176
Practice Address - Fax:512-854-2182
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095922301Medicaid