Provider Demographics
NPI:1720173826
Name:ROSALES, ROY (MS,LCDC, CCJP,LPC I)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:
Last Name:ROSALES
Suffix:
Gender:M
Credentials:MS,LCDC, CCJP,LPC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W HIBISCUS AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-9447
Mailing Address - Country:US
Mailing Address - Phone:956-668-8882
Mailing Address - Fax:
Practice Address - Street 1:130 W HIBISCUS AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-9447
Practice Address - Country:US
Practice Address - Phone:956-668-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9945101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)