Provider Demographics
NPI:1720034671
Name:ROSE, ALEXANDRIA LOUISE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRIA
Middle Name:LOUISE
Last Name:ROSE
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 1:4705 SPRING MEADOW LN
Mailing Address - Street 2:#4
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-2913
Mailing Address - Country:US
Mailing Address - Phone:432-687-2588
Mailing Address - Fax:
Practice Address - Street 1:10008 WCR 116
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-2615
Practice Address - Country:US
Practice Address - Phone:432-563-4144
Practice Address - Fax:432-561-8611
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional