Provider Demographics
NPI:1841687910
Name:ROSEBOROUGH, MISTY (LMFT)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:ROSEBOROUGH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:
Other - Last Name:MAJOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:431 CANOE WAY
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-3541
Mailing Address - Country:US
Mailing Address - Phone:310-908-7323
Mailing Address - Fax:
Practice Address - Street 1:431 CANOE WAY
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-3541
Practice Address - Country:US
Practice Address - Phone:310-908-7323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001115106H00000X
TX205003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist