Provider Demographics
NPI:1982915765
Name:ROSAS, GERMAINE M (LPC)
Entity Type:Individual
Prefix:
First Name:GERMAINE
Middle Name:M
Last Name:ROSAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15427 FALLOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1822
Mailing Address - Country:US
Mailing Address - Phone:210-326-3964
Mailing Address - Fax:
Practice Address - Street 1:7300 BLANCO RD
Practice Address - Street 2:SUITE 501
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4936
Practice Address - Country:US
Practice Address - Phone:210-326-3964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220428101Medicaid
TX9847LCOtherBCBSTX INDIVIDUAL PROVIDER RECORD ID