Provider Demographics
NPI:1659098721
Name:ROSE, KRISTY ANN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:ANN
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 CR 163
Mailing Address - Street 2:
Mailing Address - City:CISCO
Mailing Address - State:TX
Mailing Address - Zip Code:76437
Mailing Address - Country:US
Mailing Address - Phone:520-771-5264
Mailing Address - Fax:
Practice Address - Street 1:218 CR 163
Practice Address - Street 2:
Practice Address - City:CISCO
Practice Address - State:TX
Practice Address - Zip Code:76437
Practice Address - Country:US
Practice Address - Phone:520-771-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63772104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker