Provider Demographics
NPI:1710518725
Name:ROSE-GILL, JANICE K (MS LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:K
Last Name:ROSE-GILL
Suffix:
Gender:F
Credentials:MS LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 GREENLEAF DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5632
Mailing Address - Country:US
Mailing Address - Phone:512-787-5193
Mailing Address - Fax:
Practice Address - Street 1:611 GREENLEAF DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5632
Practice Address - Country:US
Practice Address - Phone:512-787-5193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82112101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health