Provider Demographics
NPI:1366294258
Name:ROSEN, JAMIE LEIGH (LPCA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEIGH
Last Name:ROSEN
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-5886
Mailing Address - Country:US
Mailing Address - Phone:972-890-4542
Mailing Address - Fax:
Practice Address - Street 1:8300 DOUGLAS AVE STE 800
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5826
Practice Address - Country:US
Practice Address - Phone:972-972-9285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93971101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional