Provider Demographics
NPI:1033350343
Name:MINA-MEZA, ROSANA E
Entity type:Individual
Prefix:
First Name:ROSANA
Middle Name:E
Last Name:MINA-MEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSANA
Other - Middle Name:E
Other - Last Name:MINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7801 OAKMONT BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4242
Mailing Address - Country:US
Mailing Address - Phone:682-841-1475
Mailing Address - Fax:682-708-3775
Practice Address - Street 1:7801 OAKMONT BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4242
Practice Address - Country:US
Practice Address - Phone:682-841-1475
Practice Address - Fax:682-708-3775
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75224101YM0800X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional