Provider Demographics
NPI:1902278302
Name:FUENTES, ROSY (LPC)
Entity Type:Individual
Prefix:
First Name:ROSY
Middle Name:
Last Name:FUENTES
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 1:2006 W KOENIG LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-1132
Mailing Address - Country:US
Mailing Address - Phone:512-740-2343
Mailing Address - Fax:
Practice Address - Street 1:15901 CENTRAL COMMERCE DR STE 506
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2046
Practice Address - Country:US
Practice Address - Phone:512-740-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-24
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1902278302Medicaid