Provider Demographics
NPI:1679728513
Name:MARY WILCOX ROSE, LLC
Entity Type:Organization
Organization Name:MARY WILCOX ROSE, LLC
Other - Org Name:NEEDFUL SLEEP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCH/SLEEP SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, CBSM
Authorized Official - Phone:713-822-1463
Mailing Address - Street 1:3139 W HOLCOMBE BLVD # 364
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1505
Mailing Address - Country:US
Mailing Address - Phone:713-822-1463
Mailing Address - Fax:
Practice Address - Street 1:10019 MAIN ST STE A9
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5257
Practice Address - Country:US
Practice Address - Phone:713-822-1463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31557103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty