Provider Demographics
NPI:1700892122
Name:REDIX, ROSE M (LPC)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:REDIX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:M
Other - Last Name:REDIX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TRANSITION SPEC
Mailing Address - Street 1:303 JAMISTON ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-1842
Mailing Address - Country:US
Mailing Address - Phone:903-306-0468
Mailing Address - Fax:903-306-0468
Practice Address - Street 1:303 JAMISTON ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-1842
Practice Address - Country:US
Practice Address - Phone:903-306-0468
Practice Address - Fax:903-306-0468
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144267504Medicaid
TX83769LOtherBLUE CROSS BLUE SHIELD