Provider Demographics
NPI:1417093238
Name:ROSALES, DEMETRIO (LPC-S)
Entity Type:Individual
Prefix:MR
First Name:DEMETRIO
Middle Name:
Last Name:ROSALES
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 MARION CIR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-3415
Mailing Address - Country:US
Mailing Address - Phone:361-851-8185
Mailing Address - Fax:
Practice Address - Street 1:4806 MARION CIR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-3415
Practice Address - Country:US
Practice Address - Phone:361-851-8185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15197101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor