Provider Demographics
NPI:1275774796
Name:ROSE, KATHERINE MARIE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:ROSE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7340 BLANCO RD
Mailing Address - Street 2:PMB - 27
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4966
Mailing Address - Country:US
Mailing Address - Phone:210-865-6931
Mailing Address - Fax:
Practice Address - Street 1:14607 SAN PEDRO AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4325
Practice Address - Country:US
Practice Address - Phone:210-865-6931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional