Provider Demographics
NPI:1447671987
Name:STUTES, ROSE BROOKS (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:BROOKS
Last Name:STUTES
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:ANN
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 66308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-6308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3455 STAGG DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4521
Practice Address - Country:US
Practice Address - Phone:832-548-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-31
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67903101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67903OtherTEXAS PROFESSIONAL COUNSELOR LICENSE