Provider Demographics
NPI:1326411752
Name:COLLEEN ROOSE
Entity Type:Organization
Organization Name:COLLEEN ROOSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-574-0616
Mailing Address - Street 1:9127 COVENT GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-3017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14811 SAINT MARYS LN
Practice Address - Street 2:STE 288
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2916
Practice Address - Country:US
Practice Address - Phone:713-714-7453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX544961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty