Provider Demographics
NPI:1396420089
Name:AMBER ROSE THERAPY AND SERVICES, PLLC
Entity type:Organization
Organization Name:AMBER ROSE THERAPY AND SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:EDISON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:580-215-9672
Mailing Address - Street 1:24301 BRAZOS TOWN CROSSING
Mailing Address - Street 2:SUITE 500, PMB #1107
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-4885
Mailing Address - Country:US
Mailing Address - Phone:580-215-9672
Mailing Address - Fax:
Practice Address - Street 1:3510 CREOLE BAY LN
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-4885
Practice Address - Country:US
Practice Address - Phone:580-215-9672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty