Provider Demographics
NPI:1881311611
Name:PUENTE, ROSA IRENE (LPC-A)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:IRENE
Last Name:PUENTE
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 RIVERCREST DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-1076
Mailing Address - Country:US
Mailing Address - Phone:469-974-2893
Mailing Address - Fax:
Practice Address - Street 1:13140 COIT RD STE 31513140
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5755
Practice Address - Country:US
Practice Address - Phone:214-682-7842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional