Provider Demographics
NPI:1932756244
Name:ROSALES, MAYRA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:
Last Name:ROSALES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MAYRA
Other - Middle Name:
Other - Last Name:ROSALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:809 KEVIN TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3759
Mailing Address - Country:US
Mailing Address - Phone:512-589-0534
Mailing Address - Fax:
Practice Address - Street 1:8700 MANCHACA RD STE 801
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5379
Practice Address - Country:US
Practice Address - Phone:512-537-5808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional