Provider Demographics
NPI:1205610631
Name:ROSE QUARTZ CENTER FOR THERAPEUTIC CHANGE LLC
Entity type:Organization
Organization Name:ROSE QUARTZ CENTER FOR THERAPEUTIC CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BASOAH-SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT ASSOCIATE
Authorized Official - Phone:619-762-8360
Mailing Address - Street 1:4900 ROSE QUARTZ DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5383
Mailing Address - Country:US
Mailing Address - Phone:619-762-8360
Mailing Address - Fax:
Practice Address - Street 1:4900 ROSE QUARTZ DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5383
Practice Address - Country:US
Practice Address - Phone:619-762-8360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health