Provider Demographics
NPI:1225800055
Name:ROSE, JODIE ANN (LMFT-A)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:ANN
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 E COUNTY ROAD 140
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-7108
Mailing Address - Country:US
Mailing Address - Phone:432-634-8726
Mailing Address - Fax:
Practice Address - Street 1:2304 E COUNTY ROAD 140
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-7108
Practice Address - Country:US
Practice Address - Phone:432-634-8726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty