Provider Demographics
NPI:1871503516
Name:ROSENKOETTER, VERONICA (TEXAS LPC 97949)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:ROSENKOETTER
Suffix:
Gender:F
Credentials:TEXAS LPC 97949
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:ROSENKOETTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1421 SPICEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4731
Mailing Address - Country:US
Mailing Address - Phone:319-759-5107
Mailing Address - Fax:
Practice Address - Street 1:1421 SPICEWOOD DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4731
Practice Address - Country:US
Practice Address - Phone:319-759-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00310101YM0800X
TX94979101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA249413OtherMIDLANDS CHOICE