Provider Demographics
NPI:1265261192
Name:GAYTAN DE LA ROSA, VERONICA (LPC)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:GAYTAN DE LA ROSA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:GAYTAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:208 HEWITT DR.
Mailing Address - Street 2:SUITE 103 #218
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6693
Mailing Address - Country:US
Mailing Address - Phone:512-686-6012
Mailing Address - Fax:512-842-7227
Practice Address - Street 1:345 OWEN LANE
Practice Address - Street 2:SUITE 102
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710
Practice Address - Country:US
Practice Address - Phone:512-686-6012
Practice Address - Fax:512-842-7227
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional