Provider Demographics
NPI:1750673976
Name:DR. DAVID ROSENTHAL, LPC, PLLC
Entity type:Organization
Organization Name:DR. DAVID ROSENTHAL, LPC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:806-799-3188
Mailing Address - Street 1:8302 INDIANA AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2835
Mailing Address - Country:US
Mailing Address - Phone:806-799-3188
Mailing Address - Fax:806-799-3190
Practice Address - Street 1:8302 INDIANA AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2835
Practice Address - Country:US
Practice Address - Phone:806-799-3188
Practice Address - Fax:806-799-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13447101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165395801Medicaid