Provider Demographics
NPI:1700364072
Name:ROSALES, PATRICIA (LPC, LCDC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:ROSALES
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:ROSALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LCDC
Mailing Address - Street 1:5959 GATEWAY BLVD W STE 450
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3396
Mailing Address - Country:US
Mailing Address - Phone:915-219-9505
Mailing Address - Fax:915-219-8546
Practice Address - Street 1:5959 GATEWAY BLVD W STE 450
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3396
Practice Address - Country:US
Practice Address - Phone:915-219-9505
Practice Address - Fax:915-219-8387
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77339101Y00000X, 101YP2500X
TX14596101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX392773304Medicaid