Provider Demographics
NPI:1629647888
Name:PETRUTSAS, ROSALYNN HERNANDEZ (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ROSALYNN
Middle Name:HERNANDEZ
Last Name:PETRUTSAS
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 1:7738 DEER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-4106
Mailing Address - Country:US
Mailing Address - Phone:214-675-1935
Mailing Address - Fax:
Practice Address - Street 1:4925 GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4026
Practice Address - Country:US
Practice Address - Phone:214-433-6433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health