Provider Demographics
NPI:1811694904
Name:ROSE, LOU ANN (LMFTA, LCDC)
Entity type:Individual
Prefix:
First Name:LOU ANN
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMFTA, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S CARROLL BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-7423
Mailing Address - Country:US
Mailing Address - Phone:469-626-7511
Mailing Address - Fax:469-613-0883
Practice Address - Street 1:501 S CARROLL BLVD STE 230
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-7423
Practice Address - Country:US
Practice Address - Phone:469-626-7511
Practice Address - Fax:469-613-0883
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15773101YA0400X
TX204433106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)